OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Evaluation of the National Tobacco Prevention and Control Public Education Campaign

ICR 201204-0920-006 · OMB 0920-0923 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0923 Non-Smoker Follow-up Questionnaire Form Modified Available
Non-Smoker Baseline Questionnaire Form Modified Available
Form 0920-xxxx Smoker Follow-up Questionnaire Form Modified Repair queued
Smoker Baseline Questionnaire Form Modified Available
Screening and Consent Form Modified Repair queued
0920-0923 Change Request Justification.docx Justification for No Material/Nonsubstantive Change Uploaded 2012-04-23 Available
Tips Banner Ads (Compiled).JPG Supplementary Document Uploaded 2012-04-23 Available
Tips Out-of-Home Compiled.JPG Supplementary Document Uploaded 2012-04-23 Repair queued
Tips Print Ads (Compiled).JPG Supplementary Document Uploaded 2012-04-23 Available
Att E-2 Email Notification and Reminders_1-6-12 (REVISED 2-7-12).doc Supplementary Document Uploaded 2012-02-17 Available
IC Document Collections
IC IDCollectionTypeStatusForm
200741 Non-Smoker Follow-up Questionnaire Form Modified
200740 Non-Smoker Baseline Questionnaire Form Modified
200739 Smoker Follow-up Questionnaire Form Modified
200738 Smoker Baseline Questionnaire Form Modified
200737 Screening and Consent Form Modified
ICR Details
0920-0923 201204-0920-006
Historical Active 201201-0920-004
HHS/CDC
Evaluation of the National Tobacco Prevention and Control Public Education Campaign
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 04/27/2012
Retrieve Notice of Action (NOA) 04/27/2012
Previous terms continue: All communications about the evaluation results via these uses of the information, including any and all Congressional testimony, will carefully enumerate and describe any underlying limitations of the data and ensure that evaluation results are interpreted with appropriate care and caution. CDC acknowledges that study design limitations decrease their capacity to draw nationally representative conclusions about either smoking-related knowledge and behavior or the impact of the campaign on long-term quit rates in sub-populations.
  Inventory as of this Action Requested Previously Approved
02/28/2013 02/28/2013 02/28/2013
55,926 0 55,926
10,015 0 10,015
0 0 0
This is a request for approval of 4 new questions on the follow-up smoker and nonsmoker surveys, to assess specific online, print, and out-of-home comapaign adverstisements.
PL: Pub.L. 111 - 148 4004 Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 111 - 31 203 Name of Law: Family Smoking Prevention and Tobacco Control Act
   US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
Yes
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 55,926 55,926 0 0 0 0
Annual Time Burden (Hours) 10,015 10,015 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$742,557
Yes Part B of Supporting Statement
No
Yes
No
No
Uncollected
Carol Walker 4046394773
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/27/2012