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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Qualitative Study on Consumer perceptions of Cigarettes Health Warning Images
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-Contact sheet Adolescent
Contact sheet_Adolescent.docx
No
Paper Only
Other-Contact sheet Adult
Contact sheet_Adult.docx
No
Paper Only
Other-GHW_Image Focus Groups Adolescent Assent Form
GHW_Image Focus Groups_Adolescent Assent Form.docx
No
Paper Only
Other-GHW_Image Focus Groups Adult Consent Form
GHW_Image Focus Groups_Adult Consent Form.docx
No
Paper Only
Other-GHW_Image Focus Groups Parent Permission Form
GHW_Image Focus Groups_Parent Permission Form.docx
No
Paper Only
Other-GHW_Image Focus Groups Screener Adolescent
GHW_Image Focus Groups_Screener_Adolescent.docx
No
Paper Only
Other-GHW_Image Focus Groups Screener Adults
GHW_Image Focus Groups_Screener_Adults.docx
No
Paper Only
Other-Set 1 Moderator Guide
Set 1 Moderator Guide.docx
No
Paper Only
Other-Set 1 Participant Booklet
Set 1 Participant Booklet.docx
No
Paper Only
Other-Set 2 Moderator Guide
Set 2 Moderator Guide.docx
No
Paper Only
Other-Set 2 Participant Booklet
Set 2 Participant Booklet.docx
No
Paper Only
Other-Set 3 Moderator Guide
Set 3 Moderator Guide.docx
No
Paper Only
Other-Set 3 Participant Booklet
Set 3 Participant Booklet.docx
No
Paper Only
Other-Set 4 Moderator Guide
Set 4 Moderator Guide.docx
No
Paper Only
Other-Set 4 Participant Booklet
Set 4 Participant Booklet.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:
2,832
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
2,832
0
2,832
0
0
0
Annual IC Time Burden (Hours)
671
0
671
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
FDA Generic Memo
FDA Generic Clearance Memo- Cigarettes Health Warning Images.docx
12/19/2017
IRB Approval
APPROVAL.PDF
12/19/2017
RIHSC Approval Letter
RIHSC approval letter.pdf
12/19/2017
RIHSC Approval Letter - Amend
RIHSC approval letter_ Amend.pdf
12/19/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.