Potential Tobacco Product Violations Reporting Mobile App Screenshot

CDC Report Violation 2_29_2012.pdf

Potential Tobacco Product Violations Reporting Form

Potential Tobacco Product Violations Reporting Mobile App Screenshot

OMB: 0910-0716

Document [pdf]
Download: pdf | pdf
Report potential violation

How Reporting
Protects Kids

Potential violations

Contact Us

About

Preferences

GPS Enabled?

YES

Choose store from list

Select potential violation type

Enter potential violation details

Review potential violations
& personal preferences

Store in List??
NO

Ready to submit?
YES

(Edit )
NO

YES
NO

Enter retailer details

Confirmation

Prepared'by

Storyboard!|!CDC!Mobile!Tobacco!Applica7ons!for!CDC!/!FDA!/!CTP!|!Version!1.2!published!Wed!Feb!29!2012

Repor&ng)Applica&on)Content)Map
!page%1!of!5

➊
Report!Poten7al!
Viola7on

➋
Select!Loca7on!

Back

Preferences

Search

Center for Tobacco Product's (CTP)

Potential Violation Reporting Tool
FDA
Logo

Select Location

HHS
Logo

Report potential violation

Nearby

Retailer
2156 Mount Vernon Ave
Home

About

Potential
Violations

Sale of cigarettes in packs less than 20
Retailers may not sell single cigarettes or packages
containing fewer than 20 cigarettes, except in vending
machines located in facilities where the retailer

.

Date

Show Details
+ Add potential
violation
Your Contact Information:
Tyson Alston
[email protected]

5 / 22 / 2011

Free samples of cigarettes
.

Change Contact Info

Submit anonymously?

Tobacco Product Type * Required

Yes

No

Disclaimer

.

Non tobacco item (i.e. lighter) given in
exchange for the purchase of a tobacco
product

Additional Potential Violation Information

Brand

Vending machines or self service displays
that contain cigarettes or smokeless
tobacco

Contact Us

About

Home

Potential
Violations

Submit

Next

Other potential violation
Contact Us

Select retailer ➌

Press to Report a
potential violation➋

Review & Submit

Retailer
2102 Mount Vernon Ave
Sale of cigarettes in packs less than 20

.

Free samples of smokeless tobacco

How do I use this application?

Back

.

Restaurant
2123 Mount Vernon Ave

Retailer
2156 Mount Vernon Ave

Enter Potential Violation Details

Sale of tobacco to minors

Sale of cigarettes in packs less than 20

Tobacco facts

Back

➎
Review!&!Submit!Poten7al!
Viola7on

Retailer
2102 Mount Vernon Ave

Retailer
2102 Mount Vernon Ave

Restaurant
2122 Mount Vernon Ave

➍
Enter!Poten7al!
Viola7on!Details

Retailer
2102 Mount Vernon Ave

Sale of Flavored Cigarettes

What potential violations can I report?

Contact Us

Select Potential Violation

7-Eleven
3600 Mount Vernon Ave

Retailer
2202 Mount Vernon Ave

Potential
Violations

Back

Add Address

All Results

Form Approved: OMB No. XXXX-XXXX
Expires XX Month XX Day, 20XX
See OMB statement in About section

Home
Home

➌
Select!Poten7al!Viola7on!
Type

About

Select potential
violation type ➍

Home

Potential
Violations

Contact Us

About

Enter potential
violation details➎

Home

Potential
Violations

Contact Us

About

Press to submit
potential violation

Descrip,on:'Submit'Viola,on''
If an address does not appear on ➋ the!user!can!search!for!a!
loca7on.!We!want!to!encourage!selec7ng!a!loca7on!if!possible,!but!do!
not!want!to!get!in!the!way!of!them!entering!one,!so!we!prominently!
included!the!"Add!Loca7on"!buPon.!See!next!page.
Visually distinguish the retailer information from the potential
violation details on !➌
Poten7al!viola7on!type!on!➌ determines!what!fields!appear!on!screen!
➍

Prepared'by

Today's date is pre-populated on ➍
The full potential violation type definition is included in the
scrolling receipt on ➍
Notes:!
Can!we!make!the!brand!a!drop!down!with!an!op7ons!for!Other/
Not!Listed!and!one!for!Unsure?!Leaving!this!as!a!free!form!text!is!
going!to!lead!to!a!a!slower!entry,!confusion,!and!a!lot!more!
mistakes.

Storyboard!|!CDC!Mobile!Tobacco!Applica7ons!for!CDC!/!FDA!/!CTP!|!Version!1.2!published!Wed!Feb!29!2012

Submit'Viola,on'
!page%2!of!5

➊
Loading!Screen

➋
Report!Poten7al!
Viola7on

Preferences

➌
Enable!GPS

Preferences

➍
Enter!Retailer!Details!

Enter Location

Back

Back

Retailer Name
Center for Tobacco Product's (CTP)

Potential Violation Reporting Tool

FDA
Logo

CTP
Logo

Street Address
FDA
Logo

HHS
Logo

Form Approved: OMB No. XXXX-XXXX
Expires XX Month XX Day, 20XX
See OMB statement in About section

violation Reporting App
Yes
No

Clicking yes will allow you to turn on your
phone's GPS settings

.

State

* Required

Loading Screen automatically
dissolves to ➋

ContactContact
Us Us

Potential
Violations

Learn
About

5 / 22 / 2011

Free samples of cigarettes

Tobacco Product Type * Required

.

Non tobacco item (i.e. lighter) given in
exchange for the purchase of a tobacco
product

* Required

Home

User does not turn on
GPS ➌

Next

Other potential violation
Potential
Violations

Contact Us

Brand

Vending machines or self service displays
that contain cigarettes or smokeless
tobacco

You will be able to add additional potential violation
information about the location before you submit

About
Home CTP

Date

.

Next
About

Retailers may not sell single cigarettes or packages
containing fewer than 20 cigarettes, except in vending
machines located in facilities where the retailer

Free samples of smokeless tobacco

City

How do I use this application?
Contact Us

Sale of cigarettes in packs less than 20

Sale of cigarettes in packs less than 20

Tobacco facts

Potential
Violations

Sale of tobacco to minors

.

Zip

Report potential violation

What potential violations can I report?

Home
Home

Retailer
2102 Mount Vernon Ave

Sale of Flavored Cigarettes

Are you
at the potential
location of the
Thecurrently
Tobacco
potential violation?

Enter Potential Violation Details

Back

Retailer
2102 Mount Vernon Ave

.

GPS is disabled

Report potential violation

Select Potential Violation

➎
Select!Poten7al!
Viola7on!Type!

About

User does not turn on
GPS ➍

Home

Potential
Violations

Contact Us

About

Enter retailer
details ➎

Home

Potential
Violations

Contact Us

About

Select potential violation

Descrip,on:'Submit'Viola,on'Loca,on''Manually'(or'GPS'off)'
When!the!applica7on!loads,!the!HHS!and!FDA!logos!will!appear!
briefly!before!dissolving!to!landing!screen!➋

The rest of the reporting flow remains the same.

If!the!user!does!not!have!their!GPS!turned!on,!they!will!see!
warning!in! ➌ The!user!does!not!need!to!have!GPS!enabled!to!
submit!a!comment.!
This!is!the!form!for!entering!a!loca7on!whether!from!nonSGPS!
version!or!clicking!"Enter!a!Loca7on"! ➍
Prepared'by

Storyboard!|!CDC!Mobile!Tobacco!Applica7ons!for!CDC!/!FDA!/!CTP!|!Version!1.2!published!Wed!Feb!29!2012

Submit'Viola,on'Loca,on''Manually'(or'GPS'off)
!page%3!of!5

➊
Home!Screen

➋
Preferences

Preferences

➍
Contact!Us

Preferences

Back

➎
Ask!CTP

Contact FDA/CTP

About

Your Full Name

Center for Tobacco Product's (CTP)

Potential Violation Reporting Tool
FDA
Logo

➌
About

Back

About FDA / CTP

Call: 1-877-287-1373

Click on a potential violation below for its definition

About This Application

Email: [email protected]

Sale of tobacco to minors

Email Compliance & Enforcement Group

Sale of Flavored Cigarettes

Tyson Alston
.

Your Email Address

HHS
Logo

[email protected]

Disclaimer

.

Sale of cigarettes in packs less than 20

Your Phone

Report potential violation

Potential Violations

OMB Statement

Visit FDA’s Tobacco Website

571-222-2222

.

Free samples of cigarettes
.

I would like a copy of my submission(s)
sent to my email above.

Form Approved: OMB No. XXXX-XXXX
Expires XX Month XX Day, 20XX
See OMB statement in About section

Yes

Yes

Save

Home
Home

Potential
Violations

Contact Us

About

View About information ➋

Home

Follow Us on Twitter

Non tobacco item (i.e. lighter) given in
exchange for the purchase of a tobacco
product

Mailing Address
Food and Drug Administration
10903 New Hampshire Ave
Silver Spring, MD 20993-0002

No

Tobacco facts
How do I use this application?

Free samples of smokeless tobacco
.

No

I would like to submit anonymously
What potential violations can I report?

Submit Your Ideas

Vending machines or self service displays
that contain cigarettes or smokeless
tobacco
Other potential violation

Disclaimer
Potential
Violations

Contact Us

About

Home

Potential
Violations

Set Preferences
➌

Contact Us

About

View Contact Us ➍

Home

Potential
Violations

Contact Us

About

Home

Potential
Violations

Contact Us

About

Email FDA CTP
➎

Descrip2on:(Preferences(&(Footer(Pages(
A user can access information about this app including
preferences and the OMB Statement by clicking About ➋

The phone number on ➍ populates that number in the phone's
interface when clicked. User can click "Call" to dial.

A user can change their preferences at any point by visiting the
about section and clicking preferences to view ➌ The first time a
user reports a violation, this information is collected prior to
completing a violation unless the user submits anonymously.

When the user taps the email address on ➍ the system launches
the default email program for the device and pre-populates the
email address.
When the user taps the physical address on ➍ the system
launches the location on Google Maps

Prepared'by

Storyboard!|!CDC!Mobile!Tobacco!Applica7ons!for!CDC!/!FDA!/!CTP!|!Version!1.2!published!Wed!Feb!29!2012

Preferences(&(Footer(Pages
!page%4!of!5

➊
About!Us

➋
OMB!Statement

About

Version!2

Contact FDA/CTP

OMB Statement

Back

About FDA / CTP

Contact FDA/CTP

Call: 1-877-287-1373

Call: 1-877-287-1373

Email: [email protected]

Email:
[email protected]
Lorem
ipsum dolor sit amet,

Email Compliance & Enforcement Group

doCompliance
eiusmod tempor
incididunt
Email
& Enforcement
Group

Form Approved: OMB No. FDA XXXX,

About This Application

Expires XX Month XX Day, 20XX

Disclaimer

OMB Paperwork Reduction Act Statement

OMB Statement

Public reporting for this collection of

consectetur adipisicing elit, sed
dolor sit amet, consectetur
adipisicing elit, sed do eiusmod
Visit FDA’s Tobacco Website
tempor

Visit FDA’s Tobacco Website

information is estimated to average 0.167 hour
per response, including the time for reviewing

Submit Your Ideas

Submit Your Ideas

Follow Us on Twitter

Follow Us on Twitter

instructions, searching existing data sources,
gathering and maintaining the data needed,
and completing and reviewing the collection of
information. Send comments regarding this
burden estimate or any other aspect of this
collection of information, including suggestions

Mailing Address
Food and Drug Administration
10903 New Hampshire Ave
Silver Spring, MD 20993-0002

Mailing Address
Food and Drug Administration
10903 New Hampshire Ave
Silver Spring, MD 20993-0002

for reducing this burden, to:

Home

Potential
Violations

Contact Us

About

Home

Potential
Violations

Contact Us

User can scroll to read
the entire statement

Displays OMB
Statement

About

Home

Potential
Violations

Contact Us

About

Home
Home

Potential
Potential
Violations
Violations

ContactUsUs
Contact

About
About

View potential
violations ➎

&About&Menu&
The OMB Statement link takes the user to the detailed view of
the OMB Paperwork Reduction Act Statement ➋

Prepared'by

Storyboard!|!CDC!Mobile!Tobacco!Applica6ons!for!CDC!/!FDA!/!CTP!|!Version!1.2!published!Wed!Feb!29!2012

About&Menu
!page%5!of!5


File Typeapplication/pdf
File TitleCDC Report Violation 12_7_2011
AuthorJason CranfordTeague.Brian Verhoeven
File Modified2012-02-29
File Created2010-09-09

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