Smoker Survey - Wave E

Extended Evaluation of the National Tobacco Prevention and Control Public Education Campaign

Documents and Forms

Document Name Document Type
Form 0920-1083 Smoker Survey - Wave E Form and Instruction
0920-1083 Smoker Survey - Wave E Attachment D-1. Smoker Survey Screenshots_9-28-22.pdf Form and Instruction
0920-1083 Smoker Survey - Wave E Attachment D-1. Smoker Survey Screenshots_9-28-22.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Smoker Survey - Wave E	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1083	Smoker Survey - Wave E	Attachment D-1. Smoker 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: 1,667	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,667	1,667
Annual IC Time Burden (Hours)	556	556
Annual IC Cost Burden (Dollars)	19,454	19,454

Documents for IC

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.