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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Qualitative Study on Acute Nicotine Toxicity Warnings for E-Liquids: 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-Moderator Guide
Appendix 1._Moderator Guide.docx
No
Printable Only
Other-Adult Screener
Appendix 2._Adult Screener.docx
No
Printable Only
Other-Youth Screener
Appendix 3._Youth Screener.docx
No
Printable Only
Other-Study Adult Consent
Appendix 4._Study Adult Consent.doc
No
Paper Only
Other-Youth Assent
Appendix 5._Youth Assent.docx
No
Paper Only
Other-Parental Permission Form
Appendix 6._Parental Permission Form.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:
2,304
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
2,304
0
2,304
0
0
0
Annual IC Time Burden (Hours)
392
0
392
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
RIHSC Approval
RIHSC Approval.pdf
01/11/2018
RTI IRB Approval Notice
RTI IRB Approval Notice.pdf
01/11/2018
OMB Justification Memo
OMB Justification Memo.docx
01/11/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.