Information Collection

Focus Group Study of Adolescent and Young Adult Perceptions Related to Cigarette Smoking

IC 202772 under ICR 201009-0910-003 · OMB 0910-0674.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0674 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Doc02_Adol Consent.pdf	Other-Consent Form
Doc03_Adult Informed Consent.pdf	Other-Consent Form
Doc04_FinalModGuideAdol YA Percept.pdf	Other-Moderator Script
Doc05_FnlScrAdolYA Percept RelCigSmok.pdf	Other-Screener Form
Doc01_Generic Memo_Adole YAt Percpt.pdf Summary Supporting Statement for Focus Group Study of Adolescent and Young Adult Perceptions Related to Cigarette Smoking	IC Document

IC Title:

Focus Group Study of Adolescent and Young Adult Perceptions Related to Cigarette Smoking

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Consent Form	Doc02_Adol Consent.pdf	Yes	Yes	Printable Only
Other-Consent Form	Doc03_Adult Informed Consent.pdf	Yes	No	Printable Only
Other-Moderator Script	Doc04_FinalModGuideAdol YA Percept.pdf	Yes	No	Printable Only
Other-Screener Form	Doc05_FnlScrAdolYA Percept RelCigSmok.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 76

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	76	0	0	0	0	0
Annual IC Time Burden (Hours)	122	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
Summary Supporting Statement for Focus Group Study of Adolescent and Young Adult Perceptions Related to Cigarette Smoking	Doc01_Generic Memo_Adole YAt Percpt.pdf	06/14/2012

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