Information Collection

Merchant Interview&Youth Focus Groups Reactions to Tobacco Product Flavor Bans

IC 214940 under ICR 201406-0910-011 · OMB 0910-0674.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 2-Chicago Merchant Interview Guide.docx	Other-Survey
Attachment 1-NYC Merchant Interview Guide.docx	Other-Survey
Attachment 3-Chicago Demographic Questionnaire.doc	Other-Questionnaire
Attachment 4-Chicago Focus Group Guide.docx	Other-Group Guide
Attachment 5-Chicago Parental Consent.doc	Other-Consent Form
Attachment 6-Chicago Participant Consent.doc	Other-Consent Form
Attachment 7-Chicago Youth Assent.docx	Other-Assent Form
Attachment 8 - Merchant Interview Recruitment Script_2-9-15.docx	Other-Merchant Recruitment Script
Attachment 9-NYC Merchant Interviews Recruitment Script.docx	Other-Recruitment Script
Attachment 10-Focus Group Recruitment Script.docx	Other-Youth Recruitment Script
Chicago Recruitment Flyer.pub Chicago Youth Recruitment Flyer	IC Document
NYC-Chicago_FDA_Abbr_Memo_-_Generic_Clearance_0910_0674.docx Merchant Interviews & Youth Focus Group Reactions to Tobacco Flavor Bans	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	Yes	Yes	Fillable Printable
Other-Survey	Yes	Yes	Fillable Printable
Other-Questionnaire	Yes	Yes	Fillable Printable
Other-Group Guide	Yes	Yes	Fillable Printable
Other-Consent Form	Yes	Yes	Fillable Printable
Other-Consent Form	Yes	Yes	Fillable Printable
Other-Assent Form	Yes	Yes	Fillable Printable
Other-Merchant Recruitment Script	Yes	Yes	Fillable Printable
Other-Recruitment Script	Yes	Yes	Fillable Printable
Other-Youth Recruitment Script	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 945

Number of Respondents for Small Entity: 345

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,100	1,100
Annual IC Time Burden (Hours)	193	193
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Chicago Youth Recruitment Flyer		02/10/2015
Merchant Interviews & Youth Focus Group Reactions to Tobacco Flavor Bans		02/11/2015

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

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