Community Web Panel Survey

[NCCDPHP] Menthol-Flavored Tobacco Products Policy Evaluation

Documents and Forms

Document Name Document Type
Form 0920-23FN Community Web Panel Survey Form
0920-23FN Web-Based Data Collection Pages 11. Attatchment 6. Screenshots of Web-Based Data Collection Pages_Menthol Policy Evaluation.pdf Form

Information Collection (IC) Details

IC Title:	Community Web Panel Survey	Agency IC Tracking Number:	0920-23FN

Is this a Common Form? No		IC Status: New

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	0920-23FN	Web-Based Data Collection Pages	11. Attatchment 6. Screenshots of Web-Based Data Collection Pages_Menthol Policy Evaluation.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,336	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,336	5,336
Annual IC Time Burden (Hours)	1,342	1,342
Annual IC Cost Burden (Dollars)	0	0

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.