Information Collection

General Market Campaign: Wave 3 Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent Youth Tobacco Use

IC 222129 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⚠️ Notice: This information collection may be referencing outdated material.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 - Parental Consent_Opt-Out Form.docx	Other-Parental Consent Opt-Out Form
Attachment B - Youth Assent Form.docx	Other-- Youth Assent Form
Attachment C - Screener.docx	Other-Screener
Attachment D - Copy Testing Questionnaire.docx	Other-Copy Testing Questionnaire
Attachment E - Advertisement Stimuli.docx	Other-Advertisement Stimuli
Attachment F - Email Scripts.docx	Other-Email Scripts
Part A - Quantitative Supporting Statement (General Market).docx Part A - Quantitative Supporting Statement (General Market)	IC Document
Part B - Quantitative Supporting Statement (General Market).docx Part B - Quantitative Supporting Statement (General Market)	IC Document
Attachment G - IRB Approval.pdf IRB Approval	IC Document
Copy of Attachment H - Recruitment Locations.xlsx Recruitment Locations	IC Document

IC Title:

General Market Campaign: Wave 3 Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent 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-Parental Consent Opt-Out Form	Attachment A - Parental Consent_Opt-Out Form.docx	No		Paper Only
Other-- Youth Assent Form	Attachment B - Youth Assent Form.docx	Yes	Yes	Fillable Fileable
Other-Screener	Attachment C - Screener.docx	Yes	Yes	Fillable Fileable
Other-Copy Testing Questionnaire	Attachment D - Copy Testing Questionnaire.docx	No		Paper Only
Other-Advertisement Stimuli	Attachment E - Advertisement Stimuli.docx	No		Paper Only
Other-Email Scripts	Attachment F - Email Scripts.docx	Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,336

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,336	10,336
Annual IC Time Burden (Hours)	969	969
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Part A - Quantitative Supporting Statement (General Market)	Part A - Quantitative Supporting Statement (General Market).docx	06/23/2016
Part B - Quantitative Supporting Statement (General Market)	Part B - Quantitative Supporting Statement (General Market).docx	06/23/2016
IRB Approval	Attachment G - IRB Approval.pdf	06/23/2016
Recruitment Locations	Copy of Attachment H - Recruitment Locations.xlsx	06/23/2016

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