OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Youth Reactions to Creative Advertising Concepts Designed to Reduce Tobacco Use among Multicultural Youth

IC 209915 under ICR 201406-0910-011 · OMB 0910-0674.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Brand Test Stimuli.doc Other-Brand Test Stimuli
Check-In Survey.pdf Other-Check In Survey and Instructio
Creative Concept Testing Stimuli.doc Other-Creative Concept Testing Stimu
Hip Hop Brand Test Survey Version A.docx Other-Hip Hop Survey A
Hip Hop Brand Test Survey Version B.docx Other-Hip Hop Survey B
Hip Hop Creative Concept Survey.xlsx Other-Hip Hop Creative Concept Surve
Moderator Guide.docx Instruction
Parental Consent Form Under 13 (RETAIN).docx Other-Parent Consent Retain
Parental Consent Form Under 13 (RETURN).docx Other-Parent Consent Return
Parental Consent Verbal Script Under 13.docx Other-Parent Consent Verbal
Parental Opt-Out Form 13 and Over.docx Other-Parent Opt Out
Participant Assent Form (RETAIN).docx Other-Participant Assent Retain
Participant Assent Form (RETURN).docx Other-Participant Assent Return
Screener .pdf Other-Initial Screener Survey
Multicultural Campaign Resh Oview_12_20_13.doc
Multicultural Campaign Resh Oview_12_20_13		IC Document
OMB Justification Memo 0910-0674.docx
OMB Justification Memo 0910-0674		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Brand Test Stimuli Brand Test Stimuli.doc Yes Yes Printable Only
Other-Check In Survey and Instruction Check-In Survey.pdf Yes Yes Printable Only
Other-Creative Concept Testing Stimuli Creative Concept Testing Stimuli.doc Yes Yes Printable Only
Other-Hip Hop Survey A Hip Hop Brand Test Survey Version A.docx Yes Yes Fillable Printable
Other-Hip Hop Survey B Hip Hop Brand Test Survey Version B.docx Yes Yes Fillable Printable
Other-Hip Hop Creative Concept Survey Hip Hop Creative Concept Survey.xlsx Yes Yes Fillable Printable
Instruction Moderator Guide.docx Yes Yes Printable Only
Other-Parent Consent Retain Parental Consent Form Under 13 (RETAIN).docx Yes Yes Fillable Printable
Other-Parent Consent Return Parental Consent Form Under 13 (RETURN).docx Yes Yes Fillable Printable
Other-Parent Consent Verbal Parental Consent Verbal Script Under 13.docx Yes Yes Fillable Printable
Other-Parent Opt Out Parental Opt-Out Form 13 and Over.docx Yes Yes Fillable Printable
Other-Participant Assent Retain Participant Assent Form (RETAIN).docx Yes Yes Fillable Printable
Other-Participant Assent Return Participant Assent Form (RETURN).docx No Yes Fillable Printable
Other-Initial Screener Survey Screener .pdf Yes Yes Printable Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested 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 580 0 0 0 0 580
Annual IC Time Burden (Hours) 192 0 0 0 0 192
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Multicultural Campaign Resh Oview_12_20_13 Multicultural Campaign Resh Oview_12_20_13.doc 12/20/2013
OMB Justification Memo 0910-0674 OMB Justification Memo 0910-0674.docx 12/20/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.