Information Collection

Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging

IC 220770 under ICR 201411-0910-008 · OMB 0910-0810.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0810 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A - Invitation and Parental Permission Form.docx	Other-Attachment A - Invitation and
Attachment B - Invitation and Youth Assent Form.docx	Other-Attachment B - Invitation and
Attachment C - Screener.docx	Other-Screener
Attachment D - Survey.docx	Other-Survey
Copy of Attachment E - Facts to be Tested.xls	Other-Facts to be Tested
GfK-Privacy-Protections-Doc.pdf	Other-Privacy Protections Document
Part A SS (Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging).docx Part A SS (Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging)	IC Document
Part B SS (Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging).docx Part B SS (Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging)	IC Document

IC Title:

Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging

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-Attachment A - Invitation and Parental Permission Form	Attachment A - Invitation and Parental Permission Form.docx	Yes	Yes	Fillable Fileable
Other-Attachment B - Invitation and Youth Assent Form	Attachment B - Invitation and Youth Assent Form.docx	Yes	Yes	Fillable Fileable
Other-Screener	Attachment C - Screener.docx	Yes	Yes	Fillable Fileable
Other-Survey	Attachment D - Survey.docx	Yes	Yes	Fillable Fileable
Other-Facts to be Tested	Copy of Attachment E - Facts to be Tested.xls	No		Printable Only
Other-Privacy Protections Document	GfK-Privacy-Protections-Doc.pdf	No		Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,251

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	6,251	6,251
Annual IC Time Burden (Hours)	1,746	1,746
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Part A SS (Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging)	Part A SS (Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging).docx	03/24/2016
Part B SS (Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging)	Part B SS (Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging).docx	03/24/2016

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