Information Collection

Qualitative Study on Nicotine: Knowledge, Beliefs, and Perceptions

IC 211997 under ICR 201404-0910-001 · OMB 0910-0497.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0497 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
FG Screener_Nicotine_Adults_Revised 6.16.14.doc	Other-Adult Screener
FG_Screener_Nicotine_Adolescent_Revised 6.16.14.doc	Other-Youth Screener
Nic FG Adult Consent Form_Revised 6.16.14.doc	Instruction
Nic FG Moderator Guide_Revised 6.16.14.docx	Other-Moderator Guide
Nic FG Parental Permission Form_Revised 6.16.14.docx	Other-Parental Permission
Nic FG Youth Assent Form_Revised 6.16.14.docx	Instruction
FDA Generic Clearance Memo for Nicotine Focus Groups_revised 6.16.14.doc OMB Justification Memo	IC Document

IC Title:

Qualitative Study on Nicotine: Knowledge, Beliefs, and Perceptions

Agency IC Tracking Number:

CTP

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-Adult Screener	FG Screener_Nicotine_Adults_Revised 6.16.14.doc	Yes	No	Fillable Printable
Other-Youth Screener	FG_Screener_Nicotine_Adolescent_Revised 6.16.14.doc	Yes	No	Fillable Printable
Instruction	Nic FG Adult Consent Form_Revised 6.16.14.doc	Yes	No	Fillable Printable
Other-Moderator Guide	Nic FG Moderator Guide_Revised 6.16.14.docx	Yes	No	Printable Only
Other-Parental Permission	Nic FG Parental Permission Form_Revised 6.16.14.docx	Yes	Yes	Fillable Printable
Instruction	Nic FG Youth Assent Form_Revised 6.16.14.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 192

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 Agency Discretion
Annual Number of Responses for this IC	192	192
Annual IC Time Burden (Hours)	510	510
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Justification Memo	FDA Generic Clearance Memo for Nicotine Focus Groups_revised 6.16.14.doc	06/19/2014

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