Quanitative Study of Youth Reactions to Rough-Cut Advertising to Prevent Youth Tobacco Use Among Multicultural Youth

Pretesting of Tobacco Communications

Documents and Forms

Document Name Document Type
Electronic Screener.doc Instruction
Parental Consent Form.docx Instruction
Parental Opt-Out.docx Instruction
Participant Assent Form.doc Instruction
Questionnaire.docx Instruction
Rough Cut Video Ad Stimuli.doc Other-Ad Stimuli
OMB Justification Memo Copy Testing.docx OMB Justification Memo IC Document

Information Collection (IC) Details

IC Title:	Quanitative Study of Youth Reactions to Rough-Cut Advertising to Prevent Youth Tobacco Use Among Multicultural Youth	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
Instruction	Electronic Screener.doc	Yes	Yes	Fillable Printable
Instruction	Parental Consent Form.docx	Yes	Yes	Fillable Printable
Instruction	Parental Opt-Out.docx	Yes	Yes	Fillable Printable
Instruction	Participant Assent Form.doc	Yes	Yes	Fillable Printable
Instruction	Questionnaire.docx	Yes	Yes	Fillable Printable
Other-Ad Stimuli	Rough Cut Video Ad Stimuli.doc	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,230	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,230	4,230
Annual IC Time Burden (Hours)	1,079	1,079
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Justification Memo	OMB Justification Memo Copy Testing.docx	09/15/2014

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