Information Collection

Youth Reactions to Creative Advertising Concepts Designed to Reduce Tobacco Use among Multicultural Youth

IC 209915 under ICR 201301-0910-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Brand Test Stimuli.doc	Other-Brand Test Stimuli
Check-In Survey.pdf	Other-Check In Survey and Instructio
Creative Concept Testing Stimuli.doc	Other-Creative Concept Testing Stimu
Hip Hop Brand Test Survey Version A.docx	Other-Hip Hop Survey A
Hip Hop Brand Test Survey Version B.docx	Other-Hip Hop Survey B
Hip Hop Creative Concept Survey.xlsx	Other-Hip Hop Creative Concept Surve
Moderator Guide.docx	Instruction
Parental Consent Form Under 13 (RETAIN).docx	Other-Parent Consent Retain
Parental Consent Form Under 13 (RETURN).docx	Other-Parent Consent Return
Parental Consent Verbal Script Under 13.docx	Other-Parent Consent Verbal
Parental Opt-Out Form 13 and Over.docx	Other-Parent Opt Out
Participant Assent Form (RETAIN).docx	Other-Participant Assent Retain
Participant Assent Form (RETURN).docx	Other-Participant Assent Return
Screener .pdf	Other-Initial Screener Survey
Multicultural Campaign Resh Oview_12_20_13.doc Multicultural Campaign Resh Oview_12_20_13	IC Document
OMB Justification Memo 0910-0674.docx OMB Justification Memo 0910-0674	IC Document

IC Title:

Youth Reactions to Creative Advertising Concepts Designed to Reduce Tobacco Use among Multicultural Youth

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Brand Test Stimuli	Brand Test Stimuli.doc	Yes	Yes	Printable Only
Other-Check In Survey and Instruction	Check-In Survey.pdf	Yes	Yes	Printable Only
Other-Creative Concept Testing Stimuli	Creative Concept Testing Stimuli.doc	Yes	Yes	Printable Only
Other-Hip Hop Survey A	Hip Hop Brand Test Survey Version A.docx	Yes	Yes	Fillable Printable
Other-Hip Hop Survey B	Hip Hop Brand Test Survey Version B.docx	Yes	Yes	Fillable Printable
Other-Hip Hop Creative Concept Survey	Hip Hop Creative Concept Survey.xlsx	Yes	Yes	Fillable Printable
Instruction	Moderator Guide.docx	Yes	Yes	Printable Only
Other-Parent Consent Retain	Parental Consent Form Under 13 (RETAIN).docx	Yes	Yes	Fillable Printable
Other-Parent Consent Return	Parental Consent Form Under 13 (RETURN).docx	Yes	Yes	Fillable Printable
Other-Parent Consent Verbal	Parental Consent Verbal Script Under 13.docx	Yes	Yes	Fillable Printable
Other-Parent Opt Out	Parental Opt-Out Form 13 and Over.docx	Yes	Yes	Fillable Printable
Other-Participant Assent Retain	Participant Assent Form (RETAIN).docx	Yes	Yes	Fillable Printable
Other-Participant Assent Return	Participant Assent Form (RETURN).docx	No	Yes	Fillable Printable
Other-Initial Screener Survey	Screener .pdf	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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 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	580	0	0	0	0	0
Annual IC Time Burden (Hours)	192	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
Multicultural Campaign Resh Oview_12_20_13	Multicultural Campaign Resh Oview_12_20_13.doc	12/20/2013
OMB Justification Memo 0910-0674	OMB Justification Memo 0910-0674.docx	12/20/2013

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