Information Collection

Underage Alcohol Use Prevention Media Campaign Focus Groups Phases 2 & 3

IC 196724 under ICR 201008-0930-002 · OMB 0930-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 3: Fema Underage Alcohol Use Prevention Media Campaign Focus Groups Phases 2 & 3	Form
Attachment 3: Fema Attachment 3: Female Screener Attachment 3 Female Parent Recruit-Screener 02-18-2011 FINAL.docx	Form
Attachment 2: Male Attachment 2: Male Screener Attachment 2 Male Parent Recruit-Screener 02-18-2011 FINAL.docx	Form
Attachment 6: Chil Attachment 6: Child Screener Attachment 6 Child Recruit-Screener 02-18-2011 FINAL.docx	Form
Attachment 1 Target Audience Plan Phase 2 02-18-2011 FINAL.docx Attachment 1: Target Audience Plan Phase 2	IC Document
Attachment 4 Moderator Guide-Parents-Messages 02-18-2011 FINAL.docx Attachment 4: Adult Guide	IC Document
Attachment 5 Message Concepts-Adult and Children 02-18-2011 FINAL.docx Attachment 5: Message Concepts-Adult and Children	IC Document
Attachment 7 Interview Guide Children 02-18-2011 FINAL.docx Attachment 7: Interview Guide Child	IC Document
Attachment 8 Parental Consent Form V1 02-18-2011 FINAL.docx Attachment 8: Parental Consent Form	IC Document
Attachment 9 9-11 Yrs Olds Interview Assent form for Children 02-18-2011 FINAL.docx Attachment 9: 9-11 IRB	IC Document
Attachment 10 12-15 Yrs Olds Interview Assent form for Children 02-18-2011 FINAL.docx Attachment 10: 12-15 IRB	IC Document
Attachment 11 Summary of $30 gift card issues 02-18-2011 FINAL.docx Attachment 11: Summary of $30 Gift Card Issues	IC Document
Supporting Statement Focus Group 02-18-2011 FINAL.docx Supporting Statement	IC Document
TransLet1-2011.doc Transmittal Letter	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Underage Alcohol Use Prevention Media Campaign Focus Groups Phases 2 & 3

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Attachment 3: Female Screener	Attachment 3: Female Screener	Attachment 3 Female Parent Recruit-Screener 02-18-2011 FINAL.docx	Yes	No	Paper Only
Form	Attachment 2: Male Screener	Attachment 2: Male Screener	Attachment 2 Male Parent Recruit-Screener 02-18-2011 FINAL.docx	Yes	No	Paper Only
Form	Attachment 6: Child Screener	Attachment 6: Child Screener	Attachment 6 Child Recruit-Screener 02-18-2011 FINAL.docx	Yes	No	Paper Only

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: 184

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	184	0	0	0	0	0
Annual IC Time Burden (Hours)	258	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 1: Target Audience Plan Phase 2	Attachment 1 Target Audience Plan Phase 2 02-18-2011 FINAL.docx	02/18/2011
Attachment 4: Adult Guide	Attachment 4 Moderator Guide-Parents-Messages 02-18-2011 FINAL.docx	02/18/2011
Attachment 5: Message Concepts-Adult and Children	Attachment 5 Message Concepts-Adult and Children 02-18-2011 FINAL.docx	02/18/2011
Attachment 7: Interview Guide Child	Attachment 7 Interview Guide Children 02-18-2011 FINAL.docx	02/18/2011
Attachment 8: Parental Consent Form	Attachment 8 Parental Consent Form V1 02-18-2011 FINAL.docx	02/18/2011
Attachment 9: 9-11 IRB	Attachment 9 9-11 Yrs Olds Interview Assent form for Children 02-18-2011 FINAL.docx	02/18/2011
Attachment 10: 12-15 IRB	Attachment 10 12-15 Yrs Olds Interview Assent form for Children 02-18-2011 FINAL.docx	02/18/2011
Attachment 11: Summary of $30 Gift Card Issues	Attachment 11 Summary of $30 gift card issues 02-18-2011 FINAL.docx	02/18/2011
Supporting Statement	Supporting Statement Focus Group 02-18-2011 FINAL.docx	02/18/2011
Transmittal Letter	TransLet1-2011.doc	02/18/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.