Information Collection

Rural Smokeless Creative Concept Testing – Focus Groups with Rural Youth

IC 212584 under ICR 201406-0910-011 · OMB 0910-0674.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A- Rural Smokeless Creative FG_Screener.docx	Instruction
Appendix B- Rural Creative FG_Discussion Guide.docx	Instruction
Appendix C- Rural Creative FG_Participant Rating Worksheet.pdf	Instruction
Appendix D- Rural Creative FG_Creative Concept &Brand Stimuli.docx	Instruction
Appendix E- Rural Creative FG_Parental Consent Form.docx	Instruction
Appendix F- Rural Creative FG_Parental Notification Form.docx	Instruction
Appendix G- Rural Creative FG_Youth Assent Form.docx	Instruction
Rural Smokeless Creative Concepts OMB Justification Memo.docx OMB Justification Memo	IC Document

IC Title:

Rural Smokeless Creative Concept Testing â Focus Groups with Rural Youth

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
Instruction	Appendix A- Rural Smokeless Creative FG_Screener.docx	Yes	No	Printable Only
Instruction	Appendix B- Rural Creative FG_Discussion Guide.docx	Yes	No	Printable Only
Instruction	Appendix C- Rural Creative FG_Participant Rating Worksheet.pdf	Yes	No	Printable Only
Instruction	Appendix D- Rural Creative FG_Creative Concept &Brand Stimuli.docx	Yes	No	Printable Only
Instruction	Appendix E- Rural Creative FG_Parental Consent Form.docx	Yes	No	Printable Only
Instruction	Appendix F- Rural Creative FG_Parental Notification Form.docx	Yes	No	Printable Only
Instruction	Appendix G- Rural Creative FG_Youth Assent Form.docx	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 576

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	576	576
Annual IC Time Burden (Hours)	384	384
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Justification Memo	Rural Smokeless Creative Concepts OMB Justification Memo.docx	08/07/2014

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