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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Multicultural Campaign: Wave 3 focus group study of reactions to creative advertising concepts designed to prevent multicultural youth tobacco use
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-Check-In Survey
Check-In Survey.pdf
No
Paper Only
Other-Creative Concept Stimuli
Creative Concept Stimuli.pdf
No
Printable Only
Other-Creative Concept Survey
Creative Concept Survey.pdf
No
Printable Only
Other-Moderator Guide
Moderator Guide.pdf
No
Printable Only
Other-Parental Consent Verbal Script
Parental Consent Verbal Script.pdf
No
Printable Only
Other-Parental Consent
Parental Consent.pdf
No
Paper Only
Other-Parental Opt Out
Parental Opt Out.pdf
No
Paper Only
Other-Participant Assent Form
Participant Assent Form.pdf
No
Paper Only
Other-Screener
Screener.pdf
No
Paper 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:
720
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
720
0
720
0
0
0
Annual IC Time Burden (Hours)
345
0
345
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
0910-0796 OMB Justification Memo
0910-0796 OMB Justification Memo.docx
12/13/2016
Protocol Approval with Modification Notice and Approval
Protocol Approval with Modification Notice and Approval Email Dec0216.pdf
12/13/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.