Information Collection

Non-smoker Follow-up Survey Wave 2

IC 210361 under ICR 201409-0920-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Non-smoker Follow-up Survey Wave 2 Form
Non-Smoker Follow-up Survey (Waves 2-4) Screenshots C-5 Nonsmoker Follow-Up Survey (Waves 2-4) Screenshots_9 04 2014.pdf Form
Spanish Non-Smoker Follow-up Survey (Waves 2-4) C-5 Nonsmoker Follow-Up Survey (Waves 2-4)_SPANISH_9 04 2014.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Non-smoker Follow-up Survey Wave 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	none	Non-Smoker Follow-up Survey (Waves 2-4) Screenshots	C-5 Nonsmoker Follow-Up Survey (Waves 2-4) Screenshots_9 04 2014.pdf		Yes	Yes	Fillable Fileable
Form	none	Spanish Non-Smoker Follow-up Survey (Waves 2-4)	C-5 Nonsmoker Follow-Up Survey (Waves 2-4)_SPANISH_9 04 2014.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 441	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	441	441
Annual IC Time Burden (Hours)	221	221
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.