Information Collection

American Indian/Alaska Native Campaign: Focus Group Study of Reactions to Strategic Concepts Designed to Prevent Youth Tobacco Use

IC 221172 under ICR 201411-0910-007 · OMB 0910-0796.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0796 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A Youth FG info.docx	Other-Youth Focus Group information
Appendix B 1 Youth Discussion Guide.docx	Other-Youth Discussion Guide
Appendix B 2 Adult Disc Guide.docx	Other-Adult Discussion Guide
Appendix C Informed_Consent_Form.docx	Other-Informed Consent Form
Appendix D Youth Assent.docx	Other-Youth Assent
Appendix E Adult FG info.docx	Other-Adult Focus Group Information
Appendix G Adult Recruit Script Screener.docx	Other-Adult Recruit Script Screener
Appendix H Youth Recruit Script Screener.docx	Other-Youth Recruit Script Screener
AI-AN OMB Memo.docx AI-AN OMB Memo	IC Document
Appendix F Sample Data Sharing Agreement.docx Sample Data Sharing Agreement	IC Document

IC Title:

American Indian/Alaska Native Campaign: Focus Group Study of Reactions to Strategic Concepts Designed to Prevent Youth Tobacco Use

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-Adult Recruit Script Screener	Appendix G Adult Recruit Script Screener.docx	No	Paper Only
Other-Youth Recruit Script Screener	Appendix H Youth Recruit Script Screener.docx	No	Paper Only
Other-Youth Focus Group information	Appendix A Youth FG info.docx	No	Paper Only
Other-Youth Discussion Guide	Appendix B 1 Youth Discussion Guide.docx	No	Paper Only
Other-Adult Discussion Guide	Appendix B 2 Adult Disc Guide.docx	No	Paper Only
Other-Informed Consent Form	Appendix C Informed_Consent_Form.docx	No	Paper Only
Other-Youth Assent	Appendix D Youth Assent.docx	No	Paper Only
Other-Adult Focus Group Information	Appendix E Adult FG info.docx	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 580

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	580	580
Annual IC Time Burden (Hours)	508	508
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
AI-AN OMB Memo	AI-AN OMB Memo.docx	04/26/2016
Sample Data Sharing Agreement	Appendix F Sample Data Sharing Agreement.docx	04/26/2016

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