Information Collection

Quantitative Study of Youth Reactions to Rough-Cut Advertising Designed to Prevent Smokeless Tobacco Use Among Rural Youth

IC 217852 under ICR 201406-0910-011 · OMB 0910-0674.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Parent-Guardian Informed Consent_Rural Smokeless Copy.docx	Other-Informed Consent
Parent-Guardian Opt-Out_Rural Smokeless Copy.docx	Other-Opt-Out
Questionnaire_Rural Smokeless Copy.docx	Other-Questionnaire
Screener_Rural Smokeless Copy.docx	Other-Screener
SCRIPTS_.DOC	Other-Scripts
YOUTH-AS.DOC	Other-Youth Assent
OMB-MEMO.DOC Supporting Statement 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	Instrument File	Available Electronically?	Electronic Capability
Other-Informed Consent	Parent-Guardian Informed Consent_Rural Smokeless Copy.docx	No	Printable Only
Other-Opt-Out	Parent-Guardian Opt-Out_Rural Smokeless Copy.docx	No	Printable Only
Other-Questionnaire	Questionnaire_Rural Smokeless Copy.docx	No	Printable Only
Other-Screener	Screener_Rural Smokeless Copy.docx	No	Printable Only
Other-Scripts	SCRIPTS_.DOC	No	Printable Only
Other-Youth Assent	YOUTH-AS.DOC	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,394

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	2,394	2,394
Annual IC Time Burden (Hours)	865	865
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Memo	OMB-MEMO.DOC	08/11/2015

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