Information Collection

Focus Groups with Rural Youth to Test Strategic Concepts Designed to Prevent Youth Smokeless Tobacco Use

IC 210333 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⚠️ Notice: This information collection may be referencing outdated material.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
Rural Smokeless Strategic Concepts FG_Parental Consent Form.docx	Other-Parental Consent Form
Rural Smokeless Strategic Concepts FG_Youth Assent Form.docx	Other-Youth Assent
Rural Strategic Concept FG_Concept Ranking Sheet_OMB.PDF	Other-Concept Ranking Sheet
Rural Strategic Concept FG_Discussion Guide.docx	Other-Discussion Guide
Rural Strategic Concept FG_Homework.docx	Other-Homework
Rural Strategic Concept FG_Image Matching Sheet_OMB.PDF	Other-Image Matching Sheet
Rural Strategic Concept FG_Participant Rating Sheet_OMB.PDF	Other-Participant Rating Sheet
Rural Strategic Concept FGs_Screener.docx	Other-Screner Document
Rural Strategic Concept FG_Image Matching Stimuli.pdf	Other-Image Matching Stimuli
Rural Strategic Concept FG_Strategic Concept Stimuli.pdf	Other-Strategic Concept Stimuli
Rural Strategic Concept FG_OMB Memo_2_7_14.doc Rural Strategic Concept FG_OMB Memo_2_7_14	IC Document

IC Title:

Focus Groups with Rural Youth to Test Strategic Concepts Designed to Prevent Youth Smokeless Tobacco Use

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-Parental Consent Form	Rural Smokeless Strategic Concepts FG_Parental Consent Form.docx	Yes	Yes	Fillable Printable
Other-Youth Assent	Rural Smokeless Strategic Concepts FG_Youth Assent Form.docx	Yes	Yes	Fillable Printable
Other-Concept Ranking Sheet	Rural Strategic Concept FG_Concept Ranking Sheet_OMB.PDF	Yes	Yes	Fillable Printable
Other-Discussion Guide	Rural Strategic Concept FG_Discussion Guide.docx	Yes	Yes	Fillable Printable
Other-Homework	Rural Strategic Concept FG_Homework.docx	Yes	Yes	Fillable Fileable
Other-Participant Rating Sheet	Rural Strategic Concept FG_Participant Rating Sheet_OMB.PDF	Yes	Yes	Fillable Printable
Other-Image Matching Sheet	Rural Strategic Concept FG_Image Matching Sheet_OMB.PDF	Yes	Yes	Fillable Printable
Other-Screner Document	Rural Strategic Concept FGs_Screener.docx	Yes	Yes	Fillable Printable
Other-Image Matching Stimuli	Rural Strategic Concept FG_Image Matching Stimuli.pdf	Yes	Yes	Printable Only
Other-Strategic Concept Stimuli	Rural Strategic Concept FG_Strategic Concept Stimuli.pdf	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 128

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	128	0	0	0	0	0
Annual IC Time Burden (Hours)	256	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
Rural Strategic Concept FG_OMB Memo_2_7_14	Rural Strategic Concept FG_OMB Memo_2_7_14.doc	02/07/2014

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