View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	The Community Tobacco Prevention Assessment and Community COVID-19 Prevention Assessment	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 and Instruction	0917-0036	Community Commercial Tobacco Use Survey	Community Commercial Tobacco Use Survey 051921f sj.docx		No		Printable Only
Form and Instruction	0917-0036	Community COVID19 Prevention Assessment	Community COVID19 Prevention Assessment sjones 071921f.docx		No		Printable 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: 1,000	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	1,000	0	1,000	0	0	0
Annual IC Time Burden (Hours)	83	0	83	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Submission Template	Generic Clearance Submission Template - IHS for Tobacco and Covid 19 Assessment Implementation.docx	03/14/2022

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