Information Collection

2013 Non-Smoker Follow-up Questionnaire (Phase 2)

IC 200741 under ICR 201306-0920-006 · OMB 0920-0923.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0923 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0923 2013 Non-Smoker Follow-up Questionnaire (Phase 2) Form and Instruction
0920-0923 Att D-2a. Nonsmoker Follow-up Survey_1 9-13 Att D-2a. Nonsmoker Follow-up Survey_1 9-13 .docx Form and Instruction
Att D-2b. Nonsmoker Survey_Screenshots Rev Dec28 v2.pdf Att D-2b. Nonsmoker Survey_Screenshots Rev Dec28 v2 IC Document
Att I-c. 2012 Nonsmoker Baseline Survey (D-1).pdf Att I-c. 2012 Nonsmoker Baseline Survey (D-1) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2013 Non-Smoker Follow-up Questionnaire (Phase 2)	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	0920-0923	Att D-2a. Nonsmoker Follow-up Survey_1 9-13	Att D-2a. Nonsmoker Follow-up Survey_1 9-13 .docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,286	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	3,286	3,286
Annual IC Time Burden (Hours)	1,369	1,369
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att D-2b. Nonsmoker Survey_Screenshots Rev Dec28 v2	Att D-2b. Nonsmoker Survey_Screenshots Rev Dec28 v2.pdf	02/07/2013
Att I-c. 2012 Nonsmoker Baseline Survey (D-1)	Att I-c. 2012 Nonsmoker Baseline Survey (D-1).pdf	02/13/2013

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