Information Collection

Tobacco Retailer Education Program: In-depth Interviews to Inform the Development of Educational Materials

IC 214141 under ICR 201406-0910-011 · OMB 0910-0674.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Discussion Guide_Final.docx	Instruction
Informed Consent Form_Final.docx	Other-Consent Form
Screener_Final.docx	Other-Screener Form
Stimuli_Fact Cards.pdf	Other-Stimuli Fact Cards
Stimuli_Variants.pdf	Other-Stimuli Variants
OMB Justification Memo Retailer Ed_Final.doc OMB Justification Memo Retailer Ed	IC Document

IC Title:

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?	Electronic Capability
Instruction	Discussion Guide_Final.docx	No	Printable Only
Other-Consent Form	Informed Consent Form_Final.docx	No	Printable Only
Other-Screener Form	Screener_Final.docx	No	Printable Only
Other-Stimuli Fact Cards	Stimuli_Fact Cards.pdf	No	Printable Only
Other-Stimuli Variants	Stimuli_Variants.pdf	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 240

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	240	240
Annual IC Time Burden (Hours)	130	130
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Justification Memo Retailer Ed	OMB Justification Memo Retailer Ed_Final.doc	12/03/2014

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