Information Collection

Wave 3 Phase 1 Qualitative Research: General Market ("The Real Cost") At-Risk Youth Tobacco Prevention Focus Groups (Change)

IC 217421 under ICR 201406-0910-011 · OMB 0910-0674.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
General Market Youth Tobacco Wave 3 Assent Form - Clean.docx	Other-Asssent Form
General Market Youth Tobacco Wave 3 Consent Form - Clean.docx	Other-Consent Form
General Market Youth Tobacco Wave 3 Discussion Guide - Clean.doc	Other-Discussion Guide
General Market Youth Tobacco Wave 3 Screener - Clean.docx	Other-Screener
General Market Youth Tobacco Wave 3 Stimuli.docx	Other-Stimuli
OMB Amendment Explanatory Memo_7_9_15.docx Explanation of changes memo	IC Document
General Market Youth Tobacco Wave 3 Memo 7.9.15.docx OMB Justification Memo	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?	Electronic Capability
Other-Asssent Form	No	Printable Only
Other-Consent Form	No	Printable Only
Other-Discussion Guide	No	Printable Only
Other-Screener	No	Printable Only
Other-Stimuli	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

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	120	120
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Explanation of changes memo		07/10/2015
OMB Justification Memo		07/10/2015

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

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