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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Online Qualitative Study of Youth Reactions to Strategic Concepts Designed to Prevent Youth Tobacco Use
Agency IC Tracking Number:
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
Other-Stimuli
Brand_NonTrier_Strategic_Concepts_STIMULI.pptx
Yes
Yes
Paper Only
Other-Discussion Guide
Discussion Guide.doc
Yes
Yes
Printable Only
Other-Parent Consent
Parent_Consent-071913.doc
Yes
Yes
Printable Only
Other-Screener
Screener.doc
Yes
Yes
Printable Only
Other-Youth Assent
Youth_Assent.doc
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
180
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
180
0
0
0
0
180
Annual IC Time Burden (Hours)
135
0
0
0
0
135
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
0674_OMB_Justification_Memo_Revised-080813
0674_OMB_Justification_Memo_Revised-080813.doc
08/08/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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