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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Gathering Consumer Feedback on the Real Cost Campaign (Cigarette Ad Focus)
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-Email invitation
Appendix A - Email Invitation for Parents of Youth FINAL.docx
Yes
Yes
Fillable Fileable
Other-Opt out form
Appendix B - Parental Opt-Out Form FINAL.docx
Yes
Yes
Fillable Fileable
Other-Youth full assent form
Appendix C - Youth Full Assent Form FINAL.docx
Yes
Yes
Fillable Fileable
Other-Brief assent and screener
Appendix D- Brief Assent and Screener FINAL.docx
Yes
Yes
Fillable Fileable
Other-Survey
Appendix E- Survey FINAL.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:
4,500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
4,500
0
4,500
0
0
0
Annual IC Time Burden (Hours)
510
0
510
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
OMB Memo / Abbreviated Supporting Statement
0810 OMB memo Cig Ad FINAL.docx
08/22/2023
IRB
0810 Cig Ad IRB.docx
08/22/2023
Research Protocol
Research Protocol Cigs FINAL.docx
08/22/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.