View Information Collection (IC)
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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 (ENDS 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 for Parents of Youth
Appendix A - Email Invitation for Parents of Youth.docx
Yes
Yes
Fillable Fileable Signable
Other-Parental Opt-Out
Appendix B - Parental Opt-Out.docx
Yes
Yes
Fillable Fileable Signable
Other-Brief Assent and Screener
Appendix C- Brief Assent and Screener.docx
Yes
Yes
Fillable Fileable Signable
Other-Youth Full Assent Form
Appendix D - Youth Full Assent Form.docx
Yes
Yes
Fillable Fileable Signable
Other-Survey
Appendix E- ENDS IMT Survey.docx
Yes
Yes
Fillable Fileable
Other-Scripts
Scripts.docx
Yes
No
Fillable Printable
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:
3,750
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
3,750
0
3,750
0
0
0
Annual IC Time Burden (Hours)
925
0
925
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
OMB Justification Memo
0810 OMB memo ENDS Ad.docx
02/23/2024
IRB Letter
IRB Letter.pdf
02/23/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.