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Federal forms, ICRs, and supporting documents

Information Collection

Qualitative Study on Cigarettes and Smoking: Knowledge, Beliefs, and Misperceptions about cigarettes and cigarette smoking

IC 215926 under ICR 201406-0910-011 · OMB 0910-0674.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
FDA Qualitative Study on Cigarettes and Smoking_Adolescent Assent Form_3-31-15.docx Other-Adolescent Assent Form
FDA Qualitative Study on Cigarettes and Smoking_Adult Consent Form_4-1-15.doc Other-Adult Consent Form
FDA Qualitative Study on Cigarettes and Smoking_FG Screener_Adolesc_4-1-15.docx Other-Screener Adolescent
FDA Qualitative Study on Cigarettes and Smoking_FG Screener_Adults_4-1-15.docx Other-Screener Adults
FDA Qualitative Study on Cigarettes and Smoking_Moderator Guide_3-31-15.docx Other-Moderator Guide
FDA Qualitative Study on Cigarettes and Smoking_New Information_List A_Adolescents_3-31-15.docx Other-New info List A - Adolescents
FDA Qualitative Study on Cigarettes and Smoking_New Information_List A_Adults_3-31-15.docx Other-New Info List A - Adults
FDA Qualitative Study on Cigarettes and Smoking_New Information_List B_Adolescents_3-31-15.docx Other-New Info List B - Adolescents
FDA Qualitative Study on Cigarettes and Smoking_New Information_List B_Adults_3-31-15.docx Other-New Info List B - Adults
FDA Qualitative Study on Cigarettes and Smoking_New Information_List C_Adults_3-31-15.docx Other-New Info List C - Adults
FDA Qualitative Study on Cigarettes and Smoking_Parental Permission Form_4-1-15.docx Other-Parental Permission Form
FDA Qualitative Study on Cigarettes and Smoking_Study Stimuli_3-31-15.doc Other-Study Stimuli
FDA Qualitative Study on Cigarettes and Smoking_Top 3 Statements_List A_Adolescents_3-31-15.docx Other-Top 3 Statements - List A Adol
FDA Qualitative Study on Cigarettes and Smoking_Top 3 Statements_List A_Adults_3-31-15.docx Other-Top 3 Statements - List A Adul
FDA Qualitative Study on Cigarettes and Smoking_Top 3 Statements_List B_Adolescents_3-31-15.docx Other-Top 3 Statements - List B Adol
FDA Qualitative Study on Cigarettes and Smoking_Top 3 Statements_List B_Adults_3-31-15.docx Other-Top 3 Statements - List B Adul
FDA Qualitative Study on Cigarettes and Smoking_Top 3 Statements_List C_Adults_3-31-15.docx Other-Top 3 Statements - List C Adul
Generic Clearance Memo FDA Qualitative Study on Cigarettes and Smoking_3-31-15.docx
Memo - Supporting Statement		IC Document

Information Collection (IC) Details

View Information Collection (IC)

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Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Adolescent Assent Form FDA Qualitative Study on Cigarettes and Smoking_Adolescent Assent Form_3-31-15.docx No   Printable Only
Other-Adult Consent Form FDA Qualitative Study on Cigarettes and Smoking_Adult Consent Form_4-1-15.doc No   Printable Only
Other-Screener Adolescent FDA Qualitative Study on Cigarettes and Smoking_FG Screener_Adolesc_4-1-15.docx No   Printable Only
Other-Screener Adults FDA Qualitative Study on Cigarettes and Smoking_FG Screener_Adults_4-1-15.docx No   Printable Only
Other-Moderator Guide FDA Qualitative Study on Cigarettes and Smoking_Moderator Guide_3-31-15.docx No   Printable Only
Other-New info List A - Adolescents FDA Qualitative Study on Cigarettes and Smoking_New Information_List A_Adolescents_3-31-15.docx No   Printable Only
Other-New Info List A - Adults FDA Qualitative Study on Cigarettes and Smoking_New Information_List A_Adults_3-31-15.docx No   Printable Only
Other-New Info List B - Adolescents FDA Qualitative Study on Cigarettes and Smoking_New Information_List B_Adolescents_3-31-15.docx No   Printable Only
Other-New Info List B - Adults FDA Qualitative Study on Cigarettes and Smoking_New Information_List B_Adults_3-31-15.docx No   Printable Only
Other-New Info List C - Adults FDA Qualitative Study on Cigarettes and Smoking_New Information_List C_Adults_3-31-15.docx No   Printable Only
Other-Parental Permission Form FDA Qualitative Study on Cigarettes and Smoking_Parental Permission Form_4-1-15.docx No   Printable Only
Other-Study Stimuli FDA Qualitative Study on Cigarettes and Smoking_Study Stimuli_3-31-15.doc No   Printable Only
Other-Top 3 Statements - List A Adolescents FDA Qualitative Study on Cigarettes and Smoking_Top 3 Statements_List A_Adolescents_3-31-15.docx No   Printable Only
Other-Top 3 Statements - List A Adults FDA Qualitative Study on Cigarettes and Smoking_Top 3 Statements_List A_Adults_3-31-15.docx No   Printable Only
Other-Top 3 Statements - List B Adolescents FDA Qualitative Study on Cigarettes and Smoking_Top 3 Statements_List B_Adolescents_3-31-15.docx No   Printable Only
Other-Top 3 Statements - List B Adults FDA Qualitative Study on Cigarettes and Smoking_Top 3 Statements_List B_Adults_3-31-15.docx No   Printable Only
Other-Top 3 Statements - List C Adults FDA Qualitative Study on Cigarettes and Smoking_Top 3 Statements_List C_Adults_3-31-15.docx No   Printable Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,208 0 2,208 0 0 0
Annual IC Time Burden (Hours) 510 0 510 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Memo - Supporting Statement Generic Clearance Memo FDA Qualitative Study on Cigarettes and Smoking_3-31-15.docx 04/01/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.