Information Collection

Underage Drinking Prevention National Media Campaign

IC 202099 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⚠️ Notice: This information collection may be referencing outdated material.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 APPENDIX 1 Underage Drinking Prevention National Media Campaign	Form and Instruction
APPENDIX 1 QUANTITATIVE PRE-LAUNCH PRE-TEST Appendix_1_Quantitative_Pre-launch_Pre-test_4-20-12[1].docx	Form and Instruction
APPENDIX 2 FORCED EXPOSURE BASELINE SURVEY Appendix_2_Forced_Exposure_Baseline_4-20-12[1].docx	Form and Instruction
APPENDIX 3 FORCED EXPOSURE FOLLOW-UP SURVEY Appendix_3_Forced_Exposure_Follow-up_4-20-12[1].docx	Form and Instruction
APPENDIX 4 NATURAL EXPOSURE BASELINE SURVEY Appendix_4_Natural_Exposure_Baseline_4-20-12[1].docx	Form and Instruction
APPENDIX 5 NATURAL EXPOSURE FOLLOW-UP SURVEY Appendix_5_Natural_Exposure_Follow-up__4-20-12[1].docx	Form and Instruction
OMB Supporting Statement 4-24-12.docx Supporting Statement	IC Document
Appendix 6 Creative Materials.pdf Appendix 6 Creative Materials.	IC Document
Appendix 7 Campaign Materials Testing Plan 4-20-12.docx Appendix 7 Campaign Materials Testing Plan	IC Document

IC Title:

Underage Drinking Prevention National Media Campaign

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 and Instruction	APPENDIX 1	QUANTITATIVE PRE-LAUNCH PRE-TEST	Appendix_1_Quantitative_Pre-launch_Pre-test_4-20-12[1].docx	Yes	Yes	Fillable Fileable
Form and Instruction	APPENDIX 2	FORCED EXPOSURE BASELINE SURVEY	Appendix_2_Forced_Exposure_Baseline_4-20-12[1].docx	Yes	Yes	Fillable Fileable
Form and Instruction	APPENDIX 3	FORCED EXPOSURE FOLLOW-UP SURVEY	Appendix_3_Forced_Exposure_Follow-up_4-20-12[1].docx	Yes	Yes	Fillable Fileable
Form and Instruction	APPENDIX 4	NATURAL EXPOSURE BASELINE SURVEY	Appendix_4_Natural_Exposure_Baseline_4-20-12[1].docx	Yes	Yes	Fillable Fileable
Form and Instruction	APPENDIX 5	NATURAL EXPOSURE FOLLOW-UP SURVEY	Appendix_5_Natural_Exposure_Follow-up__4-20-12[1].docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,250	6,250
Annual IC Time Burden (Hours)	1,808	1,808
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	OMB Supporting Statement 4-24-12.docx	04/25/2012
Appendix 6 Creative Materials.	Appendix 6 Creative Materials.pdf	04/25/2012
Appendix 7 Campaign Materials Testing Plan	Appendix 7 Campaign Materials Testing Plan 4-20-12.docx	04/25/2012

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