View Information Collection (IC)
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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Developing Brand & Creative Concepts Designed to Prevent AI/AN Youth Tobacco Use
Agency IC Tracking Number:
CTP
IC Status:
Unchanged
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-Information Packet Materials
App A.pdf
Yes
Yes
Fillable Fileable Signable
Other-Parent_Guardian Permission Form
App A1.docx
Yes
Yes
Fillable Printable
Other-Parent_Guardian Verbal Consent Script
App A2.docx
Yes
Yes
Fillable Fileable Signable
Other-Participant Assent Form
App B.docx
Yes
Yes
Fillable Printable
Other-Moderator Guide
App D.docx
Yes
No
Printable Only
Other-Screener
App C.pdf
Yes
No
Printable Only
Other-Check-In Survey
App D1.pdf
Yes
No
Fillable Fileable Signable
Other-Brand Test Survey Versions A _ B
App D2.pdf
Yes
Yes
Fillable Printable
Other-Creative Addendum
App D3.docx
Yes
Yes
Fillable Printable
Other-Creative Concepts Survey
App D4.pdf
Yes
Yes
Fillable Printable
Other-Parent_Guardian Opt-Out
App A3.docx
Yes
Yes
Fillable Printable
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:
768
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
768
0
0
0
0
768
Annual IC Time Burden (Hours)
368
0
0
0
0
368
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Justification Memo
Memo.docx
07/19/2019
IRB Approval
IRB App.pdf
07/19/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.