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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.