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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Focus Groups with Rural Youth to Test Strategic Concepts Designed to Prevent Youth Smokeless 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-Parental Consent Form
Rural Smokeless Strategic Concepts FG_Parental Consent Form.docx
Yes
Yes
Fillable Printable
Other-Youth Assent
Rural Smokeless Strategic Concepts FG_Youth Assent Form.docx
Yes
Yes
Fillable Printable
Other-Concept Ranking Sheet
Rural Strategic Concept FG_Concept Ranking Sheet_OMB.PDF
Yes
Yes
Fillable Printable
Other-Discussion Guide
Rural Strategic Concept FG_Discussion Guide.docx
Yes
Yes
Fillable Printable
Other-Homework
Rural Strategic Concept FG_Homework.docx
Yes
Yes
Fillable Fileable
Other-Image Matching Sheet
Rural Strategic Concept FG_Image Matching Sheet_OMB.PDF
Yes
Yes
Fillable Printable
Other-Participant Rating Sheet
Rural Strategic Concept FG_Participant Rating Sheet_OMB.PDF
Yes
Yes
Fillable Printable
Other-Screner Document
Rural Strategic Concept FGs_Screener.docx
Yes
Yes
Fillable Printable
Other-Image Matching Stimuli
Rural Strategic Concept FG_Image Matching Stimuli.pdf
Yes
Yes
Printable Only
Other-Strategic Concept Stimuli
Rural Strategic Concept FG_Strategic Concept Stimuli.pdf
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:
128
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
128
0
0
0
0
128
Annual IC Time Burden (Hours)
256
0
0
0
0
256
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Rural Strategic Concept FG_OMB Memo_2_7_14
Rural Strategic Concept FG_OMB Memo_2_7_14.doc
02/07/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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