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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Focus Group Study of Youth Reactions to Creative Advertising Concepts Designed to Prevent Youth Tobacco Use among Multicultural Youth
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-Instrument Pictures
Addendum A - Instrument Pictures(Final).docx
No
Printable Only
Other-Creative Concept Stimuli
Addendum B - Creative Concept Stimuli(Final).doc
No
Printable Only
Other-Photographs for Tobacco Discussion
Addendum C - Photographs for Tobacco Discussion(Final).pptx
No
Printable Only
Other-Facts for Discussion
Addendum D - Facts for Discussion(Final).docx
No
Printable Only
Other-Check-In Survey
Check-In Survey (Final).pdf
No
Printable Only
Other-Creative Concept Survey
Creative Concept Survey(Final).docx
No
Printable Only
Other-Moderator Guide
Moderator Guide(Final).docx
No
Printable Only
Other-Parental Consent Form (Retain)
Parental Consent Form (RETAIN)(Final).doc
No
Printable Only
Other-Parental Consent Form (Return)
Parental Consent Form (RETURN)(Final).doc
No
Printable Only
Other-Parental Opt-Out
Parental Opt-Out(Final).doc
No
Printable Only
Other-Participant Assent Form (Retain)
Participant Assent Form (RETAIN)(Final).doc
No
Printable Only
Other-Participant Assent Form (Return)
Participant Assent Form (RETURN)(Final).doc
No
Printable Only
Other-Screener Script
Screener Script(Final).docx
No
Printable Only
Other-Screener
Screener(Final).pdf
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,800
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
1,800
0
1,800
0
0
0
Annual IC Time Burden (Hours)
870
0
870
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement Memo
OMB Justification Memo.docx
10/15/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.