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Federal forms, ICRs, and supporting documents

Information Collection

Smoker Survery - Wave H (English and Spanish)

IC 237909 under ICR 201909-0920-005 · OMB 0920-1083.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Smoker Survery - Wave H (English and Spanish)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1083 Smoker Survey - Wave H Attachment D-1. Waves A-I Smoker Survey Screenshots 12-5-18 (English)V2.docx Yes Yes Fillable Fileable
Form and Instruction 0920-1083 Smoker Survey - Wave H Spanish Attachment D-2. Waves A-I Smoker Survey Screenshots 6-10-19 (Spanish).docx Yes Yes Fillable Fileable

Health Illness Prevention

 

1,667 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,667 0 0 1,667 0 0
Annual IC Time Burden (Hours) 556 0 0 556 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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