View Information Collection (IC)

View Information Collection (IC)

IC Title:	Questionnaire Design Research Laboratory - Testing Smoking Cessation and Oral Health Questions	Agency IC Tracking Number:

IC Status: New

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	QDRL - Testing Smoking Cessation Products and Services	QDRL OMB-10-day letter-SmokingDentalHealth att.2 quest. 0709.doc		No	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	25	0	0	0	0	0
Annual IC Time Burden (Hours)	25	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
10 day letter to Margo Schwab - justification for request	QDRL OMB-10-day letter-SmokingDentalHealth 0709.doc	07/13/2009
Attachment 1 - Advertisement for participants	QDRL OMB-10-day letter-SmokingDentalHealth att.1 0709.doc	07/13/2009

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