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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
P7. Cognitive Testing Participant SCREENER
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
0920-0621
Cognitive Testing Participant Screener
P7_Youth Screener_4.25.2018_CLEAN_3.docx
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
300
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
300
0
0
0
0
300
Annual IC Time Burden (Hours)
40
0
0
0
0
40
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
P2. Cognitive Interview Assent Form
P2_Youth Under 18 Assent Form_4.16.2018_CLEAN_2.docx
04/25/2018
P3. Cognitive Interview Consent Form
P3_Youth 18 yo Consent_4.16.2018_CLEAN_2.docx
04/25/2018
P4. Cognitive Testing Parental Permission
P4_Youth Under 18 Parental Permission_4.16.2018 rbk_IA_AG_CLEAN_2.docx
04/25/2018
P5. Youth Materials: ENDS KEY FACTS
P5_Youth Materials_ENDS Key Facts_no_tracked_changes.pdf
04/25/2018
P6. Youth Matrerials: smokefreeteen Tools for Quitting
P6_Youth Materials_Tools for Quitting_no_tracked_changes.pdf
04/25/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.