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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Increasing Understanding of Digital Advertising: Hookah Beliefs Survey
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-Screen and Survey
Attachment A_Hookah_Beliefs_Screener_and_Survey_CLEAN_120722.docx
Yes
Yes
Fillable Fileable Signable
Other-Recruitment Ads
Attachment B_Hookah_Beliefs_Recruitment_Ads_CLEAN_22323.docx
Yes
No
Fillable Printable
Other-Recruitment Ads FAQ
Attachment C_Hookah_Beliefs_Recruitment_Ads_FAQ 22323.docx
Yes
No
Fillable Printable
Other-Consent
Attachment D_Hookah_Beliefs_Informed_Consent_CLEAN_120722.docx
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
5,000
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
5,000
0
0
0
0
5,000
Annual IC Time Burden (Hours)
700
0
0
0
0
700
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement Part B
OMB Part B_FDA_Hookah_Beliefs_Survey_CLEAN_22323.docx
02/23/2023
IRB Approval
IRB_STUDY00022093.pdf
02/23/2023
Supporting Statement Part A
OMB Part A_FDA_Hookah_Beliefs_Survey_CLEAN_22323.docx
02/24/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.