View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Perceptions of Health Risk from Smokeless Tobacco Products and Nicotine Replacement Therapy among Pregnant Women and Women Planning a Pregnancy
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screener for Pregnant Women Yes No Printable Only
Other-Screener for Non-pregnant women Yes No Printable Only
Other-Moderator's Guide for Pregnant Women Yes No Printable Only
Other-Moderator's Guide for Non-Pregnant Women Yes No Printable Only
Other-Consent Form Yes No Fillable Printable

Health Consumer Health and Safety

 

792 0
   
Individuals or Households
 
   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 792 0 0 0 0 0
Annual IC Time Burden (Hours) 270 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 4 a 07/02/2013
Attachment 4b 07/02/2013
Attachment 5 07/02/2013
attachment 6a 07/02/2013
attachment 6b 07/02/2013
0920-0910_Part A_Smoking Moms_062513 07/02/2013
0920-0910_Part B_Smoking Moms_062513 07/02/2013
attachment 7 07/02/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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