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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
The Real Cost Campaign Outcomes Evaluation Study: Cohort 3
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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-ENGLISH Postcards
Attachment 03. Postcards ExPECTT 3_FU3_OMB.docx
No
Paper Only
Other-SPANISH Postcards
Attachment 03. Postcards ExPECTT 3_SPA_FU3_OMB.docx
No
Paper Only
Other-ENGLISH : Initial Lead Letter ExPECTT_Baseline (Baseline and Follow-up 2 replenishment only)
Attachment 11a. Initial Lead Letter ExPECTT 3_FU3_OMB.docx
No
Paper Only
Other-SPANISH : Initial Lead Letter ExPECTT_Baseline (Baseline and Follow-up 2 replenishment only)
Attachment 11a. Initial Lead Letter ExPECTT 3_SPA_FU3_OMB.docx
No
Paper Only
Other-ENGLISH Incentive Thank You Letter ExPECTT 3 Baseline
Attachment 14a. Incentive Thank You Letter ExPECTT 3_FU3_OMB.docx
No
Paper Only
Other-SPANISH Incentive Thank You Letter ExPECTT 3 Baseline
Attachment 14a. Incentive Thank You Letter ExPECTT 3_SPA_FU3_OMB.docx
No
Paper Only
Other-ENGLISH Email Reminders ExPECTT3 Baseline
Attachment 15. Email_reminders_ExPECTT3_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-SPANISH Email Reminders ExPECTT3 Baseline
Attachment 15. Email_reminders_ExPECTT3_SPA_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-ENGLISH Eligibility Email ExPECTT 3 Baseline
Attachment 19. Eligibility Email ExPECTT 3_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-SPANISH Eligibility Email ExPECTT 3 Baseline
Attachment 19. Eligibility Email ExPECTT 3_SPA_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-ENGLISH Eligibility Letter ExPECTT 3 Baseline
Attachment 20. Eligibility Letter ExPECTT 3_FU2_OMB.docx
No
Paper Only
Other-SPANISH Eligibility Letter ExPECTT 3 Baseline
Attachment 20. Eligibility Letter ExPECTT 3_SPA_FU3_OMB.docx
No
Paper Only
Other-ENGLISH Questions and Answers about the Health and Media Study
Attachment 21. Questions and Answers about the Health and Media Study ExPECTT 3_FU3_OMB.docx
No
Paper Only
Other-SPANISH Questions and Answers about the Health and Media Study
Attachment 21. Questions and Answers about the Health and Media Study_SPA_FU3_OMB.docx
No
Paper Only
Other-ENGLISH Invitation Emails ExPECTT 3 Baseline
Attachment 23. Invitation Emails ExPECTT 3_FU3_OMB.docx
Yes
Yes
Printable Only
Other-SPANISH Invitation Emails ExPECTT 3 Baseline
Attachment 23. Invitation Emails ExPECTT 3_SPA_FU3_OMB.docx
Yes
No
Printable Only
Other-Text Message Reminder
Attachment 10. Text Message Reminder_Parent_Youth_ExPECTT 3_FU3_OMB.docx
Yes
No
Printable Only
Other-ENGLISH Parent Guardian Online Screener
Attachment 02. Parent Guardian Screener_ExPECTT 3_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-SPANISH Parent Guardian Screener
Attachment 02. Parent Guardian Screener_ExPECTT 3_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-ENGLISH Parent Guardian Permission
Attachment 04. Parent Guardian Permission ExPECTT 3_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-SPANISH Parent Guardian Permission
Attachment 04. Parent Guardian Permission ExPECTT 3_SPA_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-ENGLISH Youth Assent 11 to 13 ExPECTT 3
Attachment 05a. Youth Assent 11 to 13 ExPECTT 3_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-SPANISH Youth Assent 11 to 13 ExPECTT 3
Attachment 05a. Youth Assent 11 to 13 ExPECTT 3_SPA_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-ENGLISH Youth Assent 14+ ExPECTT 3
Attachment 05b. Youth Assent 14+ ExPECTT 3_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-SPANISH Youth Assent 14+ ExPECTT 3
Attachment 05b. Youth Assent 14+ ExPECTT 3_SPA_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-ENGLISH Young Adult Consent ExPECTT 3
Attachment 06. Young Adult Consent ExPECTT 3_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-SPANISH Young Adult Consent ExPECTT 3
Attachment 06. Young Adult Consent ExPECTT 3_SPA_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-ENGLISH Youth Survey ExPECTT3
Attachment 9. Youth Survey ExPECTT3.docx
Yes
Yes
Fillable Printable
Other-SPANISH Youth Survey ExPECTT 3
Attachment 09. Youth Survey ExPECTT 3_SPA_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-ENGLISH Panel Maintenance ExPECTT 3
Attachment 24. Panel Maintenance ExPECTT 3_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-SPANISH Panel Maintenance ExPECTT 3
Attachment 24. Panel Maintenance ExPECTT 3_SPA_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-ENGLISH Reminder Letters ExPECTT 3
Attachment 25. Reminder Letters ExPECTT 3_FU3_OMB.docx
Yes
Yes
Fillable Printable
Other-SPANISH Reminder Letters ExPECTT 3
Attachment 25. Reminder Letters ExPECTT 3_SPA_FU3_OMB.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:
609,031
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
99 %
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
609,031
0
0
134,031
0
475,000
Annual IC Time Burden (Hours)
59,799
0
0
-11,451
0
71,250
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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