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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
The Real Cost Smokeless: Wave 2 Focus Group Study of Reactions to Creative Advertising Concepts Designed to Prevent Rural 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-Screener
Attachment A - Screener.docx
Yes
Yes
Fillable Printable
Other-Parent-Guardian Permission Form
Attachment B1- Parent-Guardian Permission Form.docx
No
Paper Only
Other-Parent-Guardian Opt-out Form
Attachment B2- Parent-Guardian Opt-out Form.docx
No
Paper Only
Other-Youth Assent Form
Attachment C - Youth Assent Form.docx
No
Paper Only
Other-Discussion Guide
Attachment D - Discussion Guide.docx
No
Paper Only
Other-Study Stimuli
Attachment E- Study Stimuli.docx
No
Printable Only
Other-Concept Rating Worksheet
Attachment F - Concept Rating Worksheet.docx
No
Paper Only
Other-Concept Ranking Worksheet
Attachment G - Concept Ranking Worksheet.docx
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:
576
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
576
0
576
0
0
0
Annual IC Time Burden (Hours)
276
0
276
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Generic Memo
Smokeless W2 OMB Memo.docx
12/11/2017
IRB Letter
Attachment H - IRB Letter.pdf
12/11/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.