Information Collection

Qualitative Study on Consumer perceptions of Cigarettes Health Warning Images

IC 229494 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⚠️ Notice: This information collection may be referencing outdated material.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
Contact sheet_Adolescent.docx	Other-Contact sheet Adolescent
Contact sheet_Adult.docx	Other-Contact sheet Adult
GHW_Image Focus Groups_Adolescent Assent Form.docx	Other-GHW_Image Focus Groups Adolesc
GHW_Image Focus Groups_Adult Consent Form.docx	Other-GHW_Image Focus Groups Adult C
GHW_Image Focus Groups_Parent Permission Form.docx	Other-GHW_Image Focus Groups Parent
GHW_Image Focus Groups_Screener_Adolescent.docx	Other-GHW_Image Focus Groups Screene
GHW_Image Focus Groups_Screener_Adults.docx	Other-GHW_Image Focus Groups Screene
Set 1 Moderator Guide.docx	Other-Set 1 Moderator Guide
Set 1 Participant Booklet.docx	Other-Set 1 Participant Booklet
Set 2 Moderator Guide.docx	Other-Set 2 Moderator Guide
Set 2 Participant Booklet.docx	Other-Set 2 Participant Booklet
Set 3 Moderator Guide.docx	Other-Set 3 Moderator Guide
Set 3 Participant Booklet.docx	Other-Set 3 Participant Booklet
Set 4 Moderator Guide.docx	Other-Set 4 Moderator Guide
Set 4 Participant Booklet.docx	Other-Set 4 Participant Booklet
FDA Generic Clearance Memo- Cigarettes Health Warning Images.docx FDA Generic Memo	IC Document
APPROVAL.PDF IRB Approval	IC Document
RIHSC approval letter.pdf RIHSC Approval Letter	IC Document
RIHSC approval letter_ Amend.pdf RIHSC Approval Letter - Amend	IC Document

IC Title:

Qualitative Study on Consumer perceptions of Cigarettes Health Warning Images

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-Contact sheet Adolescent	Contact sheet_Adolescent.docx	No	Paper Only
Other-Contact sheet Adult	Contact sheet_Adult.docx	No	Paper Only
Other-GHW_Image Focus Groups Adolescent Assent Form	GHW_Image Focus Groups_Adolescent Assent Form.docx	No	Paper Only
Other-GHW_Image Focus Groups Adult Consent Form	GHW_Image Focus Groups_Adult Consent Form.docx	No	Paper Only
Other-GHW_Image Focus Groups Parent Permission Form	GHW_Image Focus Groups_Parent Permission Form.docx	No	Paper Only
Other-GHW_Image Focus Groups Screener Adolescent	GHW_Image Focus Groups_Screener_Adolescent.docx	No	Paper Only
Other-GHW_Image Focus Groups Screener Adults	GHW_Image Focus Groups_Screener_Adults.docx	No	Paper Only
Other-Set 1 Moderator Guide	Set 1 Moderator Guide.docx	No	Paper Only
Other-Set 1 Participant Booklet	Set 1 Participant Booklet.docx	No	Paper Only
Other-Set 2 Moderator Guide	Set 2 Moderator Guide.docx	No	Paper Only
Other-Set 2 Participant Booklet	Set 2 Participant Booklet.docx	No	Paper Only
Other-Set 3 Moderator Guide	Set 3 Moderator Guide.docx	No	Paper Only
Other-Set 3 Participant Booklet	Set 3 Participant Booklet.docx	No	Paper Only
Other-Set 4 Moderator Guide	Set 4 Moderator Guide.docx	No	Paper Only
Other-Set 4 Participant Booklet	Set 4 Participant Booklet.docx	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,832

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	2,832	2,832
Annual IC Time Burden (Hours)	671	671
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FDA Generic Memo	FDA Generic Clearance Memo- Cigarettes Health Warning Images.docx	12/19/2017
IRB Approval	APPROVAL.PDF	12/19/2017
RIHSC Approval Letter	RIHSC approval letter.pdf	12/19/2017
RIHSC Approval Letter - Amend	RIHSC approval letter_ Amend.pdf	12/19/2017

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