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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Nicotine Education Project
Agency IC Tracking Number:
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-Young Adult Consent Form
Appendix A NEP Online Survey Young Adult Consent Form.docx
Yes
Yes
Fillable Fileable
Other-Youth Assent Form
Appendix B NEP Online Survey Youth Assent Form.docx
Yes
Yes
Fillable Fileable
Other-Survey Instrument
Appendix C NEP Online Survey.docx
Yes
Yes
Fillable Fileable
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:
8,040
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
12,048
0
0
0
0
12,048
Annual IC Time Burden (Hours)
1,254
0
0
0
0
1,254
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
IRB Approval Document
IRB Approval NEP.pdf
03/10/2022
Supporting Statement A
OMB_Supporting Statement_Part A_NEP Clean 5.31.docx
05/31/2022
Supporting Statement B
OMB_Supporting Statement_Part B_NEP Clean 5.31.docx
05/31/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.