OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

The Real Cost Smokeless: Wave 2 In-depth Interviews Designed to Prevent Rural Youth Tobacco Use

IC 229407 under ICR 201411-0910-007 · OMB 0910-0796.

Documents and Forms
Document Name
Document Type
Other-Screener
Other-Parent Guardian Permission For
Other-Parent Guardian Opt-out Form
Other-Youth Assent Form
Other-Discussion Guide
Other-Google Map Example Center of T
Other-Tobacco Product Image Boards
Other-Interview Activity
Other-Google Map Example Entire Town
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

The Real Cost Smokeless: Wave 2 In-depth Interviews Designed to Prevent Rural Youth Tobacco Use CTP
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screener Attachment A - Screener.docx Yes Yes Fillable Printable
Other-Parent Guardian Permission Form Attachment B - Parent Guardian Permission.docx No   Paper Only
Other-Parent Guardian Opt-out Form Attachment C - Parent Guardian Opt-out.docx No   Paper Only
Other-Youth Assent Form Attachment D - Youth Assent Form.docx No   Paper Only
Other-Discussion Guide Attachment E - Discussion Guide.docx No   Paper Only
Other-Google Map Example Center of Town Attachment F - Map Example Center of Town.pdf No   Printable Only
Other-Tobacco Product Image Boards Attachment H - Tobacco Product Image Boards.pdf No   Paper Only
Other-Interview Activity Attachment I - Interview Activity.docx No   Paper Only
Other-Google Map Example Entire Town Attachment G - Map Example Entire Town.pdf No   Printable Only

Health Consumer Health and Safety

 

88 0
   
Individuals or Households
 
   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 88 0 88 0 0 0
Annual IC Time Burden (Hours) 54 0 54 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
OMB Memo SMKLS W2 IDI OMB Memo.docx 12/12/2017
IRB Letter Attachment J - IRB Letter.pdf 12/12/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.