Information Collection

Multicultural Campaign: Wave 3 focus group study of reactions to creative advertising concepts designed to prevent multicultural youth tobacco use

IC 224800 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⚠️ Notice: This information collection may be referencing outdated material.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
Check-In Survey.pdf	Other-Check-In Survey
Creative Concept Stimuli.pdf	Other-Creative Concept Stimuli
Creative Concept Survey.pdf	Other-Creative Concept Survey
Moderator Guide.pdf	Other-Moderator Guide
Parental Consent Verbal Script.pdf	Other-Parental Consent Verbal Script
Parental Consent.pdf	Other-Parental Consent
Parental Opt Out.pdf	Other-Parental Opt Out
Participant Assent Form.pdf	Other-Participant Assent Form
Screener.pdf	Other-Screener
0910-0796 OMB Justification Memo.docx 0910-0796 OMB Justification Memo	IC Document
Protocol Approval with Modification Notice and Approval Email Dec0216.pdf Protocol Approval with Modification Notice and Approval	IC Document

IC Title:

Multicultural Campaign: Wave 3 focus group study of reactions to creative advertising concepts designed to prevent multicultural 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-Check-In Survey	Check-In Survey.pdf	No	Paper Only
Other-Creative Concept Stimuli	Creative Concept Stimuli.pdf	No	Printable Only
Other-Creative Concept Survey	Creative Concept Survey.pdf	No	Printable Only
Other-Moderator Guide	Moderator Guide.pdf	No	Printable Only
Other-Parental Consent Verbal Script	Parental Consent Verbal Script.pdf	No	Printable Only
Other-Parental Consent	Parental Consent.pdf	No	Paper Only
Other-Parental Opt Out	Parental Opt Out.pdf	No	Paper Only
Other-Participant Assent Form	Participant Assent Form.pdf	No	Paper Only
Other-Screener	Screener.pdf	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 720

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	720	720
Annual IC Time Burden (Hours)	345	345
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0910-0796 OMB Justification Memo	0910-0796 OMB Justification Memo.docx	12/13/2016
Protocol Approval with Modification Notice and Approval	Protocol Approval with Modification Notice and Approval Email Dec0216.pdf	12/13/2016

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