OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202106-0920-001 · OMB 0920-1083 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-1083 Nonsmoker Survey - Wave I (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Nonsmoker Survey - Wave H (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Nonsmoker Survey - Wave G (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Nonsmoker Survey - Wave F (English and Spanish) Form and Instruction Modified Missing upstream
Form 0920-1083 Smoker Survery - Wave I (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Smoker Survery - Wave H (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Smoker Survery - Wave G (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Smoker Survery - Wave F (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Nonsmoker Survey - Wave E (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Smoker Survey - Wave E (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Smoker Survey - Wave A (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Non-smoker Survey - Wave D (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Non-smoker Survey - Wave C (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Non-smoker Survey - Wave B (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Non-smoker Survey - Wave A (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Smoker Survey - Wave D (English and Spanish) Form and Instruction Modified Missing upstream
Form 0920-1083 Smoker Survey - Wave C (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Smoker Survey - Wave B (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Screening and Consent (English and Spanish) Form and Instruction Unchanged Repair queued
Non_Sub Change Crosswalk 04JUN2021.docx Supplementary Document Uploaded 2021-06-07 Repair queued
2020 NTEC Change Request 0920_1083 _9_23_20_a.docx Justification for No Material/Nonsubstantive Change Uploaded 2021-06-07 Available
684_NTEC.pdf Supplementary Document Uploaded 2019-10-07 Repair queued
Privacy Narrative PDF OMB 0920_1083_12_19_18 signed 09-12-19.pdf Supplementary Document Uploaded 2019-10-07 Missing upstream
Attachment J. Source of Respondents for Each Wave of Data Collection.docx Supplementary Document Uploaded 2019-10-07 Repair queued
Attachment I-3. ABS Sample Postcard Reminders.pdf Supplementary Document Uploaded 2019-10-07 Repair queued
Attachment I-2. KnowledgePanel Email Invitation Reminders.doc Supplementary Document Uploaded 2019-10-07 Repair queued
Attachment I-1. ABS Sample Invitation Letters.pdf Supplementary Document Uploaded 2019-10-07 Repair queued
Attachment H. GfK-Ipsos Privacy and Security Procedures.doc Supplementary Document Uploaded 2019-10-07 Missing upstream
Attachment G. RTI IRB Approval Notice.pdf Supplementary Document Uploaded 2019-10-07 Repair queued
Attachment F. KnowledgePanel Recruitment Procedures.doc Supplementary Document Uploaded 2019-10-07 Missing upstream
Attachment E-3. Changes to Wave A-I Nonsmoker Survey 12-5-18.docx Supplementary Document Uploaded 2019-10-07 Repair queued
Attachment D-3. Changes to Wave A-I Smoker Survey Updated.docx Supplementary Document Uploaded 2019-10-09 Repair queued
Attachment B-1. 60-Day FRN Published 4-23-19.pdf Supplementary Document Uploaded 2019-10-07 Repair queued
Attachment A-3. PPHF.pdf Supplementary Document Uploaded 2019-10-07 Repair queued
Attachment A-2. Familly Smoking Prevention & Tobacco Control Act.PDF Supplementary Document Uploaded 2019-10-07 Repair queued
Attachment A-1. Public Health Service Act.doc Supplementary Document Uploaded 2019-10-07 Missing upstream
Part B_Evaluation ICR_6-10-19.docx Supporting Statement B Uploaded 2019-10-07 Repair queued
Part A_Evaluation ICR_6-10-19 final.docx Supporting Statement A Uploaded 2019-10-07 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
237915 Nonsmoker Survey - Wave I (English and Spanish) Form and Instruction Modified
237914 Nonsmoker Survey - Wave H (English and Spanish) Form and Instruction Modified
237912 Nonsmoker Survey - Wave G (English and Spanish) Form and Instruction Modified
237911 Nonsmoker Survey - Wave F (English and Spanish) Form and Instruction Modified
237910 Smoker Survery - Wave I (English and Spanish) Form and Instruction Modified
237909 Smoker Survery - Wave H (English and Spanish) Form and Instruction Modified
237907 Smoker Survery - Wave G (English and Spanish) Form and Instruction Modified
237906 Smoker Survery - Wave F (English and Spanish) Form and Instruction Modified
228674 Nonsmoker Survey - Wave E (English and Spanish) Form and Instruction Modified
228673 Smoker Survey - Wave E (English and Spanish) Form and Instruction Modified
218056 Smoker Survey - Wave A (English and Spanish) Form and Instruction Modified
217194 Non-smoker Survey - Wave D (English and Spanish) Form and Instruction Modified
217193 Non-smoker Survey - Wave C (English and Spanish) Form and Instruction Modified
217192 Non-smoker Survey - Wave B (English and Spanish) Form and Instruction Modified
217191 Non-smoker Survey - Wave A (English and Spanish) Form and Instruction Modified
217190 Smoker Survey - Wave D (English and Spanish) Form and Instruction Modified
217189 Smoker Survey - Wave C (English and Spanish) Form and Instruction Modified
217188 Smoker Survey - Wave B (English and Spanish) Form and Instruction Modified
217186 Screening and Consent (English and Spanish) Form and Instruction Unchanged
ICR Details
0920-1083 202106-0920-001
Received in OIRA 201909-0920-005
HHS/CDC 0920-1083-21FP
Extended Evaluation of the National Tobacco Prevention and Control Public Education Campaign
No material or nonsubstantive change to a currently approved collection   No
Regular 06/07/2021
  Requested Previously Approved
03/31/2023 03/31/2023
40,434 40,434
9,308 9,308
232,096 232,096
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 Non-Substantive Change Request is submitted to consider the potential impact of COVID-19 on cigarette smoking cessation and the potential impact on campaign outcomes.
PL: Pub.L. 111 - 148 4001 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 31 123 Name of Law: Family Smoking Prevention and Tobacco Control
   US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  84 FR 16863 04/23/2019
84 FR 54151 10/09/2019
No
19
IC Title Form No. Form Name
Non-smoker Survey - Wave A (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Nonsmoker Survey - Wave A ,   Nonsmoker Survey - Wave A Spanish ,   Nonsmoker Survey Wave A_English 04JUN2021 ,   Nonsmoker Survey Wave A_Spanish 04JUN2021
Non-smoker Survey - Wave B (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Nonsmoker Survey - Wave B ,   Nonsmoker Survey - Wave B Spanish ,   Nonsmoker Survey Wave B_English 04JUN2021 ,   Nonsmoker Survey Wave B_Spanish 04JUN2021
Non-smoker Survey - Wave C (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Nonsmoker Survey - Wave C ,   Nonsmoker Survey - Wave C Spanish ,   Nonsmoker Survey Wave C_English 04JUN2021 ,   Nonsmoker Survey Wave C_Spanish 04JUN2021
Non-smoker Survey - Wave D (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Nonsmoker Survey - Wave D ,   Nonsmoker Survey - Wave D Spanish ,   Nonsmoker Survey Wave D_English 04JUN2021 ,   Nonsmoker Survey Wave D_Spanish 04JUN2021
Nonsmoker Survey - Wave E (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Nonsmoker Survey - Wave E ,   Nonsmoker Survey - Wave E Spanish ,   Nonsmoker Survey Wave E_English 04JUN2021 ,   Nonsmoker Survey Wave E_Spanish 04JUN2021
Nonsmoker Survey - Wave F (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Nonsmoker Survey - Wave F ,   Nonsmoker Survey - Wave F Spanish ,   Nonsmoker Survey Wave F_English 04JUN2021 ,   Nonsmoker Survey Wave F_Spanish 04JUN2021
Nonsmoker Survey - Wave G (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Nonsmoker Survey - Wave G ,   Nonsmoker Survey - Wave G Spanish ,   Nonsmoker Survey Wave G_English 04JUN2021 ,   Nonsmoker Survey Wave G_Spanish 04JUN2021
Nonsmoker Survey - Wave H (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Nonsmoker Survey - Wave H ,   Nonsmoker Survey - Wave H Spanish ,   Nonsmoker Survey Wave H_English 04JUN2021 ,   Nonsmoker Survey Wave H_Spanish 04JUN2021
Nonsmoker Survey - Wave I (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Nonsmoker Survey - Wave I ,   Nonsmoker Survey - Wave I Spanish ,   Nonsmoker Survey Wave I_English 04JUN2021 ,   Nonsmoker Survey Wave I_Spanish 04JUN2021
Screening and Consent (English and Spanish) 0920-1083, 0920-1083 Screening and Consent ,   Screener and Consent Spanish
Smoker Survery - Wave F (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Smoker Survey - Wave F ,   Smoker Survey - Wave F Spanish ,   Smoker Survey Wave F_English 04JUN2021 ,   Smoker Survey Wave F_Spanish 04JUN2021
Smoker Survery - Wave G (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Smoker Survey - Wave G ,   Smoker Survey - Wave G Spanish ,   Smoker Survey Wave G_English 04JUN2021 ,   Smoker Survey Wave G_Spanish 04JUN2021
Smoker Survery - Wave H (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Smoker Survey - Wave H ,   Smoker Survey - Wave H Spanish ,   Smoker Survey Wave H_English 04JUN2021 ,   Smoker Survey Wave H_Spanish 04JUN2021
Smoker Survery - Wave I (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Smoker Survey - Wave I ,   Smoker Survey - Wave I Spanish ,   Smoker Survey Wave I_English 04JUN2021 ,   Smoker Survey Wave I_Spanish 04JUN2021
Smoker Survey - Wave A (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Smoker Survey - Wave A ,   Smoker Suvey - Wave A Spanish ,   Smoker Survey Wave A_English 04JUN2021 ,   Smoker Survey Wave A_Spanish 04JUN2021
Smoker Survey - Wave B (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Smoker Survey - Wave B ,   Smoker Survey - Wave B Spanish ,   Smoker Survey Wave B _English 04JUN2021 ,   Smoker Survey Wave B_Spanish 04JUN2021
Smoker Survey - Wave C (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Smoker Survey - Wave C ,   Smoker Survey -- Wave C Spanish ,   Smoker Survey Wave C_English 04JUN2021 ,   Smoker Survey Wave C_Spanish 04JUN2021
Smoker Survey - Wave D (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Smoker Suvey - Wave D ,   Smoker Survey - Wave D Spanish ,   Smoker Survey Wave D_English 04JUN2021 ,   Smoker Survey Wave D_Spanish 04JUN2021
Smoker Survey - Wave E (English and Spanish) 0920-1083, 0920-1083, 0920-1083, 0920-1083 Smoker Survey - Wave E ,   Smoker Survey - Wave E Spanish ,   Smoker Survey Wave E_English 04JUN2021 ,   Smoker Survey Wave E_Spanish 04JUN2021
  Total Request 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 40,434 40,434 0 0 0 0
Annual Time Burden (Hours) 9,308 9,308 0 0 0 0
Annual Cost Burden (Dollars) 232,096 232,096 0 0 0 0
No
No
$3,530,745
Yes Part B of Supporting Statement
    Yes
    No
Yes
No
No
No
Jeffrey Zirger 404 639-7118 [email protected]
  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.
06/07/2021