Information Collection Request

Population Assessment of Tobacco and Health (PATH) Study (NIDA)

ICR 201307-0925-001 · OMB 0925-0664 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 PATH/Baseline-Adults-Biospecimen: Blood Form and Instruction New Available
Form 1 PATH/Baseline-Adults-Biospecimen: Buccal Form and Instruction New Available
Form 1 PATH - Adults - Followup/Tracking Participant Information Form for Shadow Sample Youth(completed ny Parents)/Field Test Form and Instruction Modified Available
Form 2h PATH - Adult- Parent Interview/Field Test Form Removed Available
Form 2g PATH - Youth Extended Interview/Field Test Form Removed Available
Form 2f PATH - Adults- Followup/Traacking Participant Information Form/Field Test Form Removed Available
Form 2e PATH - Tobacco Use Form/Field Test Form Removed Available
Form 2d PATH - Biospecimen Collection Forms/Field Test Form and Instruction Removed Available
Form 2c PATH - Adults - Extended Interview/Field Test Form Removed Available
Form 2b PATH - Adults - Individual Screener/Field Test Form Removed Available
Form 2a PATH - Adults Household Screener/Field Test Form Removed Available
Form 1 PATH/Baseline- Adults - Followup/Tracking Participant Information Form for Youth (completed by parents) Form and Instruction Modified Available
Form 1 PATH/Baseline- Adult-Parent Interview Form and Instruction Modified Available
Form 1 PATH/Baseline-Youth Extended Interview Form and Instruction Modified Available
Form 1 PATH/Baseline- Adults-Followup/Tracking Participant Information Form Form and Instruction Modified Available
Form 1 PATH/Baseline- Adults -Tobacco Use Form Form and Instruction Modified Repair queued
Form 1 PATH/Baseline-Adults-Biospecimen: Urine Form and Instruction Modified Available
Form 1 PATHBaseline- Adult Extended Interview Form and Instruction Modified Available
Form 1 PATH/Baseline - Adults Individual Screener Form and Instruction Modified Available
Form 1 PATH/Baseline- Adults Household Screener Form and Instruction Modified Available
PATH terms of clearance - draft2 8-22-13.doc Supplementary Document Uploaded 2013-08-23 Available
PATH Study Revised SSB 6-24-13.doc Supporting Statement B Uploaded 2013-06-27 Available
23 List of Statistical Consultants v3.pdf Supplementary Document Uploaded 2013-06-28 Available
22 Precision Calculations under Best and Worst-case Scenarios v5 6-20-2013.pdf Supplementary Document Uploaded 2013-06-28 Available
21 Sample Analysis Plans.pdf Supplementary Document Uploaded 2013-06-28 Available
19 ICPSR Data Use Agreement.pdf Supplementary Document Uploaded 2013-06-28 Available
18 Procedures for Keeping Data Confidential.pdf Supplementary Document Uploaded 2013-06-28 Available
17 Privacy Act SORN.pdf Supplementary Document Uploaded 2013-06-28 Available
16 IRB Approval Memo.pdf Supplementary Document Uploaded 2013-06-28 Available
15 Assurance of Confidentiality.pdf Supplementary Document Uploaded 2013-06-28 Available
14 PATH_Confidentiality_Certificate.pdf Supplementary Document Uploaded 2013-06-28 Available
11 List of Consultants v4.pdf Supplementary Document Uploaded 2013-06-28 Available
10 Public Comments from 60-day FRN.pdf Supplementary Document Uploaded 2013-06-28 Available
8 Key Design Features-SOURCE.pdf Supplementary Document Uploaded 2013-06-28 Available
7 PATH Study Privacy Impact Assessments (PIA).pdf Supplementary Document Uploaded 2013-06-28 Available
6 Additional Information on biospecimens 6-7-13.pdf Supplementary Document Uploaded 2013-06-28 Available
5 Sample Conceptual Models v2.pdf Supplementary Document Uploaded 2013-06-28 Available
2 PATH_Field_Test_Summary of Findings + Report v4 6-22-2013.pdf Supplementary Document Uploaded 2013-06-28 Available
1 NIDA's Data Collection Authority.pdf Supplementary Document Uploaded 2013-06-28 Available
4 Crosswalk of PATH Study Objectives, Data Sources, Domains, and Analysis.pdf Supplementary Document Uploaded 2013-06-28 Available
PATH Study Memo for Non-Substantive Change Request-Baseline NIDA 06-24-13.doc Supplementary Document Uploaded 2013-06-27 Available
PATH Study Memo for Non-Substantive Change Request-Baseline NIDA 06-28-13.doc Justification for No Material/Nonsubstantive Change Uploaded 2013-06-28 Repair queued
3d-Spanish. Biospecimen Collection Forms.pdf Supplementary Document Uploaded 2013-06-28 Available
3d-Spanish. Biospecimen Collection Forms.pdf Supplementary Document Uploaded 2013-06-28 Available
3j-Spanish. Followup Tracking Participant Information Form - Shadow Sample Youth.pdf Supplementary Document Uploaded 2013-06-28 Available
3i-Spanish. Followup Tracking Participant Information Form - Youth.pdf Supplementary Document Uploaded 2013-06-28 Available
3h. Spanish. PATH Wave 1 Parent Interview 7.5 2013-06-10.pdf Supplementary Document Uploaded 2013-06-28 Available
3g. Spanish. PATH Wave 1 Youth Extended Interview 7.5 2013-06-10.pdf Supplementary Document Uploaded 2013-06-28 Available
3e. Spanish. PATH Wave 1 Tobacco Use Form 2013-06-10.pdf Supplementary Document Uploaded 2013-06-28 Available
3d-Spanish. Biospecimen Collection Forms.pdf Supplementary Document Uploaded 2013-06-28 Available
3c. Spanish. PATH Wave 1 Adult Extended Interview 7.5 2013-06-10.pdf Supplementary Document Uploaded 2013-06-28 Available
3b. Spanish. PATH Wave 1 Individual Screener 7.5 2013-06-10.pdf Supplementary Document Uploaded 2013-06-28 Available
3a. Spanish. PATH Wave 1 Household Screener 7.5 2013-06-10.pdf Supplementary Document Uploaded 2013-06-28 Available
PATH Study SSA 8-14-13- clean.doc Supporting Statement A Uploaded 2013-08-23 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
207613 PATH/Baseline-Adults-Biospecimen: Blood Form and Instruction New
207612 PATH/Baseline-Adults-Biospecimen: Buccal Form and Instruction New
203772 PATH - Adults - Followup/Tracking Participant Information Form for Shadow Sample Youth(completed ny Parents)/Field Test Form and Instruction Modified
203771 PATH - Adult- Parent Interview/Field Test Form Removed
203770 PATH - Youth Extended Interview/Field Test Form Removed
203769 PATH - Adults- Followup/Traacking Participant Information Form/Field Test Form Removed
203768 PATH - Tobacco Use Form/Field Test Form Removed
203767 PATH - Biospecimen Collection Forms/Field Test Form and Instruction Removed
203766 PATH - Adults - Extended Interview/Field Test Form Removed
203765 PATH - Adults - Individual Screener/Field Test Form Removed
203764 PATH - Adults Household Screener/Field Test Form Removed
203763 PATH/Baseline- Adults - Followup/Tracking Participant Information Form for Youth (completed by parents) Form and Instruction Modified
203762 PATH/Baseline- Adult-Parent Interview Form and Instruction Modified
203761 PATH/Baseline-Youth Extended Interview Form and Instruction Modified
203760 PATH/Baseline- Adults-Followup/Tracking Participant Information Form Form and Instruction Modified
203759 PATH/Baseline- Adults -Tobacco Use Form Form and Instruction Modified
203758 PATH/Baseline-Adults-Biospecimen: Urine Form and Instruction Modified
203757 PATHBaseline- Adult Extended Interview Form and Instruction Modified
203756 PATH/Baseline - Adults Individual Screener Form and Instruction Modified
203755 PATH/Baseline- Adults Household Screener Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2015 11/30/2015 11/30/2015
560,451 0 450,546
136,889 0 121,572
0 0 0





Reginfo record details
12
table that charts list of burden
IC Title Form No. Form Name
PATH/Baseline- Adults -Tobacco Use Form 1 Tobacco Use Form
PATH/Baseline- Adults Household Screener 1 Household Screener
PATH/Baseline - Adults Individual Screener 1 Individual Screener
PATHBaseline- Adult Extended Interview 1 Extended Interview
PATH/Baseline-Adults-Biospecimen: Urine 1 Urine Collection
PATH/Baseline- Adults-Followup/Tracking Participant Information Form 1 Follow-up/Tracking Participant Information Form
PATH/Baseline-Youth Extended Interview 1 Youth Extended Interview
PATH/Baseline- Adult-Parent Interview 1 Parent Interview
PATH/Baseline- Adults - Followup/Tracking Participant Information Form for Youth (completed by parents) 1 Follow-up/Tracking Participant Information Form (completed by parents)
PATH - Adults - Followup/Tracking Participant Information Form for Shadow Sample Youth(completed ny Parents)/Field Test 1 Shadow Sample
PATH/Baseline-Adults-Biospecimen: Buccal 1 Buccal Collection
PATH/Baseline-Adults-Biospecimen: Blood 1 Blood Collection
PATH - Adults Household Screener/Field Test 2a Household Screener/Field Test
PATH - Adults - Individual Screener/Field Test 2b Individual Screener/Field Test
PATH - Adults - Extended Interview/Field Test 2c Extended Interview/Field Test
PATH - Biospecimen Collection Forms/Field Test 2d Biospecimen Collection Forms/Field Test
PATH - Tobacco Use Form/Field Test 2e Tobacco Use Form/Field Test
PATH - Adults- Followup/Traacking Participant Information Form/Field Test 2f Followup Tracking Participant/Field Test
PATH - Youth Extended Interview/Field Test 2g Youth Extended Interview/Field Test
PATH - Adult- Parent Interview/Field Test 2h Parent Interview/Field Test

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 560,451 450,546 0 80,175 29,730 0
Annual Time Burden (Hours) 136,889 121,572 0 24,191 -8,874 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No