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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Qualitative Study on Nicotine: Knowledge, Beliefs, and Perceptions
Agency IC Tracking Number:
CTP
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
Other-Adult Screener
FG Screener_Nicotine_Adults_Revised 6.16.14.doc
Yes
No
Fillable Printable
Other-Youth Screener
FG_Screener_Nicotine_Adolescent_Revised 6.16.14.doc
Yes
No
Fillable Printable
Instruction
Nic FG Adult Consent Form_Revised 6.16.14.doc
Yes
No
Fillable Printable
Other-Moderator Guide
Nic FG Moderator Guide_Revised 6.16.14.docx
Yes
No
Printable Only
Other-Parental Permission
Nic FG Parental Permission Form_Revised 6.16.14.docx
Yes
Yes
Fillable Printable
Instruction
Nic FG Youth Assent Form_Revised 6.16.14.docx
Yes
Yes
Fillable Printable
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:
192
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
192
0
192
0
0
0
Annual IC Time Burden (Hours)
510
0
510
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
OMB Justification Memo
FDA Generic Clearance Memo for Nicotine Focus Groups_revised 6.16.14.doc
06/19/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.