Information Collection

Non-smoker Survey - Wave A

IC 217191 under ICR 202209-0920-012 · OMB 0920-1083.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1083 Non-smoker Survey - Wave A	Form and Instruction
0920-1083 Nonsmoker Survey - Wave A Attachment E-1. Nonsmoker Survey Screenshots_9-28-22.pdf	Form and Instruction
0920-1083 Nonsmoker Survey - Wave A Attachment E-1. Nonsmoker Survey Screenshots_9-28-22.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1083	Nonsmoker Survey - Wave A	Attachment E-1. Nonsmoker Survey Screenshots_9-28-22.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,100	1,100
Annual IC Time Burden (Hours)	366	366
Annual IC Cost Burden (Dollars)	12,848	12,848

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.