Information Collection

The Real Cost Smokeless: Wave 2 Focus Group Study of Reactions to Creative Advertising Concepts Designed to Prevent Rural Youth Tobacco Use

IC 229406 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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment A - Screener.docx	Other-Screener
Attachment B1- Parent-Guardian Permission Form.docx	Other-Parent-Guardian Permission For
Attachment B2- Parent-Guardian Opt-out Form.docx	Other-Parent-Guardian Opt-out Form
Attachment C - Youth Assent Form.docx	Other-Youth Assent Form
Attachment D - Discussion Guide.docx	Other-Discussion Guide
Attachment E- Study Stimuli.docx	Other-Study Stimuli
Attachment F - Concept Rating Worksheet.docx	Other-Concept Rating Worksheet
Attachment G - Concept Ranking Worksheet.docx	Other-Concept Ranking Worksheet
Smokeless W2 OMB Memo.docx Generic Memo	IC Document
Attachment H - IRB Letter.pdf IRB Letter	IC Document

IC Title:

The Real Cost Smokeless: Wave 2 Focus Group Study of Reactions to Creative Advertising Concepts Designed to Prevent Rural 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?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener	Attachment A - Screener.docx	Yes	Yes	Fillable Printable
Other-Parent-Guardian Permission Form	Attachment B1- Parent-Guardian Permission Form.docx	No		Paper Only
Other-Parent-Guardian Opt-out Form	Attachment B2- Parent-Guardian Opt-out Form.docx	No		Paper Only
Other-Youth Assent Form	Attachment C - Youth Assent Form.docx	No		Paper Only
Other-Discussion Guide	Attachment D - Discussion Guide.docx	No		Paper Only
Other-Study Stimuli	Attachment E- Study Stimuli.docx	No		Printable Only
Other-Concept Rating Worksheet	Attachment F - Concept Rating Worksheet.docx	No		Paper Only
Other-Concept Ranking Worksheet	Attachment G - Concept Ranking Worksheet.docx	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 576

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	576	576
Annual IC Time Burden (Hours)	276	276
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Memo	Smokeless W2 OMB Memo.docx	12/11/2017
IRB Letter	Attachment H - IRB Letter.pdf	12/11/2017

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