Information Collection

LGBT Campaign: Focus Group Study of Brand and Creative Concepts Designed to Prevent LGBT Young Adult Tobacco Use

IC 215003 under ICR 201406-0910-011 · OMB 0910-0674.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screener LGBT.docx	Other-screener
Consent Form_Retain LGBT.docx	Other-consent form for participant t
Consent Form_Return LGBT.docx	Other-consent form for participant t
Moderator Guide LGBT.docx	Other-focus group moderator guide
Brand Test Survey Version A LGBT.docx	Other-survey (brand test v. A)
Brand Test Survey Version B LGBT.docx	Other-survey (brand test v. B)
Addendum A - Brand Testing Stimuli LGBT.pdf	Other-brand test stimuli
Addendum B - Creative Concept Testing Stimuli LGBT.docx	Other-creative concept testing stimu
Creative Concept Survey LGBT.xlsx	Other-creative concept survey
OMB Justification Memo_LGBT_BCC.docx Abbreviated Supporting Statement/OMB memo 0910-0674 LGBT	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
Other-screener	Screener LGBT.docx	No	Printable Only
Other-consent form for participant to retain	Consent Form_Retain LGBT.docx	No	Paper Only
Other-consent form for participant to return	Consent Form_Return LGBT.docx	No	Paper Only
Other-focus group moderator guide	Moderator Guide LGBT.docx	No	Paper Only
Other-survey (brand test v. A)	Brand Test Survey Version A LGBT.docx	No	Paper Only
Other-survey (brand test v. B)	Brand Test Survey Version B LGBT.docx	No	Paper Only
Other-brand test stimuli	Addendum A - Brand Testing Stimuli LGBT.pdf	No	Paper Only
Other-creative concept testing stimuli	Addendum B - Creative Concept Testing Stimuli LGBT.docx	No	Paper Only
Other-creative concept survey	Creative Concept Survey LGBT.xlsx	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 896

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	896	896
Annual IC Time Burden (Hours)	448	448
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Abbreviated Supporting Statement/OMB memo 0910-0674 LGBT	OMB Justification Memo_LGBT_BCC.docx	02/13/2015

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