Information Collection

Fresh Empire Campaign: Wave 2 Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent Youth Tobacco Use

IC 222137 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⚠️ Notice: This information collection may be referencing outdated material.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 - Screener (In-Person Electronic).docx	Other-Screener (In-Person Electronic
Attachment B - Screener (In-Person Paper).pdf	Other-Screener (In-Person Paper)
Attachment C - Screener (Social Media Electronic).docx	Other-Screener (Social Media Electro
Attachment D - Copy Testing Questionnaire.docx	Other-Copy Testing Questionnaire
Attachment E - Parental Opt-Out (In-Person).docx	Other-Parental Opt-Out (In-Person)
Attachment F - Parental Consent Form (In-Person).docx	Other-Parental Consent Form (In-Pers
Attachment G - Parental Consent Verbal Script (In-Person).docx	Other-Parental Consent Verbal Script
Attachment H - Parental Opt-Out (Social Media).docx	Other-Parental Opt-Out (Social Media
Attachment I - Participant Assent Form (In-Person).docx	Other-Participant Assent Form (In-Pe
Attachment J - Participant Assent Form (Social Media).docx	Other-Participant Assent Form (Socia
Attachment K - Social Media Advertisements.docx	Other-Social Media Advertisements
Attachment L - Video Ad Stimuli.docx	Other-Video Ad Stimuli
Part A - Quantitative Supporting Statement (Fresh Empire Campaign.Wave 2.docx Part A - Quantitative Supporting Statement (Fresh Empire Campaign.Wave 2	IC Document
Part B - Quantitative Supporting Statement (Fresh Empire Campaign.Wave 2.docx Part B - Quantitative Supporting Statement (Fresh Empire Campaign.Wave 2	IC Document
Attachment M - IRB Approval Letter.pdf IRB Approval Letter	IC Document

IC Title:

Fresh Empire Campaign: Wave 2 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 Opt-Out (Social Media)	Attachment H - Parental Opt-Out (Social Media).docx	Yes	Yes	Fillable Fileable
Other-Participant Assent Form (In-Person)	Attachment I - Participant Assent Form (In-Person).docx	Yes	Yes	Fillable Fileable
Other-Participant Assent Form (Social Media)	Attachment J - Participant Assent Form (Social Media).docx	Yes	Yes	Fillable Fileable
Other-Social Media Advertisements	Attachment K - Social Media Advertisements.docx	Yes	No	Printable Only
Other-Video Ad Stimuli	Attachment L - Video Ad Stimuli.docx	Yes	No	Printable Only
Other-Parental Consent Verbal Script (In-Person)	Attachment G - Parental Consent Verbal Script (In-Person).docx	No		Paper Only
Other-Screener (In-Person Electronic)	Attachment A - Screener (In-Person Electronic).docx	Yes	Yes	Fillable Fileable
Other-Screener (In-Person Paper)	Attachment B - Screener (In-Person Paper).pdf	No		Paper Only
Other-Screener (Social Media Electronic)	Attachment C - Screener (Social Media Electronic).docx	Yes	Yes	Fillable Fileable
Other-Copy Testing Questionnaire	Attachment D - Copy Testing Questionnaire.docx	Yes	Yes	Fillable Fileable
Other-Parental Opt-Out (In-Person)	Attachment E - Parental Opt-Out (In-Person).docx	No		Paper Only
Other-Parental Consent Form (In-Person)	Attachment F - Parental Consent Form (In-Person).docx	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 19,310

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	19,310	19,310
Annual IC Time Burden (Hours)	1,531	1,531
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Part A - Quantitative Supporting Statement (Fresh Empire Campaign.Wave 2	Part A - Quantitative Supporting Statement (Fresh Empire Campaign.Wave 2.docx	06/23/2016
Part B - Quantitative Supporting Statement (Fresh Empire Campaign.Wave 2	Part B - Quantitative Supporting Statement (Fresh Empire Campaign.Wave 2.docx	06/23/2016
IRB Approval Letter	Attachment M - IRB Approval Letter.pdf	06/23/2016

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