OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 0920-1083 · HHS/CDC.

OMB 0920-1083

This study will enable Centers for Disease Control and Prevention (CDC) to continue to measure exposure and awareness of the Tips From Former Smokers ® campaign and to evaluate its impact on campaign-targeted outcomes among smokers and nonsmokers in the United States. This ICR is being submitted as a revision with minor changes of a longitudinal web-based survey previously approved as OMB No. 0920-1083.

The latest form for Extended Evaluation of the National Tobacco Prevention and Control Public Education Campaign expires 2023-03-31 and is listed under ICR 201909-0920-005.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 0920-1083 Nonsmoker Survey - Wave IForm and Instruction
Form 0920-1083 Nonsmoker Survey - Wave HForm and Instruction
Form 0920-1083 Nonsmoker Survey - Wave GForm and Instruction
Form 0920-1083 Nonsmoker Survey - Wave FForm and Instruction
Form 0920-1083 Smoker Survery - Wave IForm and Instruction
Form 0920-1083 Smoker Survery - Wave HForm and Instruction
Form 0920-1083 Smoker Survery - Wave GForm and Instruction
Form 0920-1083 Smoker Survery - Wave FForm and Instruction
Form 0920-1083 Nonsmoker Survey - Wave EForm and Instruction
Form 0920-1083 Smoker Survey - Wave EForm and Instruction
Form 0920-1083 Smoker Survey - Wave AForm and Instruction
Form 0920-1083 Non-smoker Survey - Wave DForm and Instruction
Form 0920-1083 Non-smoker Survey - Wave CForm and Instruction
Form 0920-1083 Non-smoker Survey - Wave BForm and Instruction
Form 0920-1083 Non-smoker Survey - Wave AForm and Instruction
Form 0920-1083 Smoker Survey - Wave DForm and Instruction
Form 0920-1083 Smoker Survey - Wave CForm and Instruction
Form 0920-1083 Smoker Survey - Wave BForm and Instruction
Form 0920-1083 Screening and ConsentForm and Instruction
Attachment C-1. Changes to Waves A-I Screener Survey (004).docx Supplementary Document
privacy-narrative-form 08_05_22 OMB 0920_1083.pdf Supplementary Document
Attachment J. Source of Respondents for Each Wave of Data Collection.docx Supplementary Document
Attachment I-3. ABS Sample Postcard Reminders.pdf Supplementary Document
Attachment I-2. KnowledgePanel Email Invitation Reminders (005)_final.docx Supplementary Document
Attachment I-1. ABS Sample Invitation Letters.pdf Supplementary Document
Attachment H. Ipsos Privacy and Security Procedures.docx Supplementary Document
STARS_Project-Summary-0900f3eb81ccd0c4-9-9-2022-10_58_51.pdf Supplementary Document
Attachment F. KnowledgePanel Recruitment Procedures_.docx Supplementary Document
Attachment E-2. Changes to Wave A-I Nonsmoker Survey (006)_.docx Supplementary Document
Attachment D-2. Changes to Waves A-I Smoker Survey_.docx Supplementary Document
Attachment B-1. 60-day Federal Register Notice, Docket No. CDC_2022-0071.pdf Supplementary Document
Attachment A-3. PPHF.pdf Supplementary Document
Attachment A-2. Familly Smoking Prevention & Tobacco Control Act.PDF Supplementary Document
Attachment A-1. Public Health Service Act.docx Supplementary Document
SSB 2022 Part B_Evaluation ICR (002)_bcl_clean_8_24_22v2_final.docxSupporting Statement B
SSA_2022 Part A_Evaluation ICR (003) (002) Clean 8_24_22_1_final.docxSupporting Statement A
Nonsmoker Survey - Wave I Form and Instruction
Nonsmoker Survey - Wave H Form and Instruction
Nonsmoker Survey - Wave G Form and Instruction
Nonsmoker Survey - Wave F Form and Instruction
Smoker Survery - Wave I Form and Instruction
Smoker Survery - Wave H Form and Instruction
Smoker Survery - Wave G Form and Instruction
Smoker Survery - Wave F Form and Instruction
Nonsmoker Survey - Wave E Form and Instruction
Smoker Survey - Wave E Form and Instruction
Smoker Survey - Wave A Form and Instruction
Non-smoker Survey - Wave D Form and Instruction
Non-smoker Survey - Wave C Form and Instruction
Non-smoker Survey - Wave B Form and Instruction
Non-smoker Survey - Wave A Form and Instruction
Smoker Survey - Wave D Form and Instruction
Smoker Survey - Wave C Form and Instruction
Smoker Survey - Wave B Form and Instruction
Screening and Consent Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202209-0920-012 Revision of a currently approved collection 2022-09-30 Approved without change
202204-0920-015 No material or nonsubstantive change to a currently approved collection 2022-05-02 Approved without change
202106-0920-001 No material or nonsubstantive change to a currently approved collection 2021-06-07 Approved without change
201909-0920-005 Revision of a currently approved collection 2019-10-10 Approved without change
201709-0920-003 Reinstatement with change of a previously approved collection 2017-10-18 Approved without change
201506-0920-005 New collection (Request for a new OMB Control Number) 2015-07-10 Approved with change

OMB Details

Screening and Consent (English and Spanish)

Federal Enterprise Architecture: Health - Illness Prevention

Information collection instruments
FormNameElectronic accessType
Form 0920-1083Screener and Consent SpanishFillable FileableForm and instruction
Form 0920-1083Screening and ConsentFillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.