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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Qualitative Research to Design Advertising to Encourage Quitting Among Adult Cigarette Smokers (SGM Population) (CTP
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-Consent Form - Virtual
Attachment A - Consent Form - Virtual.docx
Yes
Yes
Fillable Fileable
Other-Consent Form - In Person
Attachment A - Consent Form In-Person.docx
Yes
Yes
Fillable Printable
Other-Screener
Attachment B - Participant Screener SGM OMB 3.13.20 Clean.docx
Yes
No
Paper Only
Other-Screener Contact
Attachment C -Screener Contact.docx
Yes
Yes
Fillable Fileable
Other-Discussion Guide
Attachment D - Discussion Guide SGM OMB-3.13.20 Clean.docx
Yes
No
Printable Only
Other-Concept Rating
Attachment E - Concept Rating.docx
Yes
Yes
Fillable Fileable
Other-Stimuli
Attachment F - Stimuli_SGM OMB 3.13.2020 Clean.docx
Yes
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:
600
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
600
0
600
0
0
0
Annual IC Time Burden (Hours)
450
0
450
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
0796 OMB Approval Memo
0796 OMB Approval Memo for Research to Design Ad to Encourage Quitting Smoking (SGM Pop) 2020.docx
02/13/2020
IRB Approval Letter
IRB Approval Letter 2020.pdf
02/13/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.