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LGBT Young Adult Tobacco Use Prevention Campaign: Copy Testing
Pretesting of Tobacco Communications
OMB: 0910-0674
IC ID: 218027
OMB.report
HHS/FDA
OMB 0910-0674
ICR 201406-0910-011
IC 218027
( )
Documents and Forms
Document Name
Document Type
LGBT Copy Consent.docx
Other-Consent
LGBT Copy Electronic Screener.docx
Other-Electronic Screener
LGBT Copy Paper Screener.pdf
Other-Paper Screener
LGBT Copy Questionnaire.docx
Other-Questionnaire
LGBT Copy Stimuli.docx
Other-Stimuli
OMB Justification Memo_LGBT.docx
Memo - Supporting Statement
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
LGBT Young Adult Tobacco Use Prevention Campaign: Copy Testing
Agency IC Tracking Number:
CTP
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Consent
LGBT Copy Consent.docx
Yes
Yes
Fillable Fileable
Other-Electronic Screener
LGBT Copy Electronic Screener.docx
Yes
Yes
Fillable Fileable
Other-Paper Screener
LGBT Copy Paper Screener.pdf
No
Printable Only
Other-Questionnaire
LGBT Copy Questionnaire.docx
Yes
Yes
Fillable Fileable
Other-Stimuli
LGBT Copy Stimuli.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
11,500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
11,500
0
11,500
0
0
0
Annual IC Time Burden (Hours)
1,278
0
1,278
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Memo - Supporting Statement
OMB Justification Memo_LGBT.docx
08/26/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.