Evaluation of the Food and Drug Administration's 'Fresh Empire' Multicultural Youth Tobacco Prevention Campaign.

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
FE SS OMB_Part A.docx	Supporting Statement A	Uploaded 2015-05-21	Available
FE SS OMB_PartB 5.15.docx	Supporting Statement B	Uploaded 2015-05-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
216679	Cross-Sectional Cohort Second post-test evaluation survey	Other-Incentive Lit Review	New
216678	Cross-Sectional Cohort Second post-test evaluation survey	Other-Incentive Lit Review	New
216677	Cross-Sectional Cohort First post-test evaluation survey	Other-Incentive Lit Review	New
216676	Longitudinal Cohort Third post-test evaluation survey	Other-Incentive Lit Review	New
216675	Longitudinal Cohort Second post-test evaluation survey	Other-Incentive Lit Review	New
216672	Adults 18 and older in the United States - Screener and Consent Process- third post-test outcome survey	Other-Informed consent and Assent	New
216669	Adults 18 and older in the United States - Screener and Consent Process- second post-test outcome survey	Other-Informed consent and Assent	New
216668	Youth aged 12 to 17 in the United States - Screener and Consent Process- Third post-test outcome survey	Other-Outcome Web Screener	New
216667	Youth aged 12 to 17 in the United States - Screener and Consent Process- second post-test outcome survey	Other-Outcome Web Screener	New
215952	Multicultural youth aged 13-17 in the select media markets recruiting through social media and online panels - Post-test online survey	Other-Reminder Postcard	New
215951	Multicultural youth aged 13-17 in the select media markets recruiting through social media and online panels - Post-test online screener	Other-Outcome Parent Lead Letter	New
215950	Multicultural youth aged 13-17 in the select media markets recruiting through social media and online panels - Pre-test online survey	Other-Non Disclosure Agreement	New
215948	Multicultural youth aged 13-17 in the select media markets recruiting through social media and online panels - Pre-test online screener	Other-b. Questions and Answers Fact Sheet	New
215947	Longitudinal Cohort - First post-test evaluation survey	Other-Verification Form	New
215945	Multicultural Youth aged 12-17 in select media markets - Pre-test outcome evaluation survey	Other-Social Media Ad	New
215944	Adults 18 and older in the United States - Screener and Consent Process- first post-test outcome survey	Other-Informed Consent and Assent	New
215943	Youth aged 12 to 17 in the United States - Screener and Consent Process- first post-test outcome survey	Other-Outcome Web screener	New
215942	Adults 18 and older in the United States - Screener and Consent Process-Pre-test outcome survey	Other-Outcome Mail Screener	New
215941	Youth aged 12 to 17 in the United States - Screener and Consent Process-Pre-test outcome survey	Other-Pre and Post Compaign	New

ICR Details

OMB Control No: 0910-0788	ICR Reference No: 201504-0910-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/FDA	Agency Tracking No: CTP
Title: Evaluation of the Food and Drug Administration's 'Fresh Empire' Multicultural Youth Tobacco Prevention Campaign.
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/22/2015
	Date Received in OIRA: 04/15/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved
Responses	106,648	0	0
Time Burden (Hours)	13,678	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Food and Drug Administration (FDA) requests Office of Management and Budget (OMB) approval to conduct in-person and Web-based surveys of multicultural youth in the United States, as the Evaluation of the Fresh Empire Campaign on Tobacco (EFECT). These surveys will be fielded for purposes of evaluating FDA's Fresh Empire public education campaign for multicultural youth 12 to 17 years old. The primary outcome evaluation will consist of a pre-test survey and ongoing cross-sectional surveys beginning approximately 3 months following the campaign launch. Data from this evaluation will be used to gauge campaign awareness and examine the statistical relationships between exposure to the campaign and changes in outcome variables of interest.

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Authorizing Statute(s): PL: Pub.L. 111 - 31 1003(d)(2)(D) Name of Law: Federal Food, Drug, and Cosmetic Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 230	01/05/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 19673	04/13/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 19

table that charts list of burden

IC Title	Form No.	Form Name
Multicultural Youth aged 12-17 in select media markets - Pre-test outcome evaluation survey
Youth aged 12 to 17 in the United States - Screener and Consent Process-Pre-test outcome survey
Youth aged 12 to 17 in the United States - Screener and Consent Process- first post-test outcome survey
Adults 18 and older in the United States - Screener and Consent Process- first post-test outcome survey
Longitudinal Cohort - First post-test evaluation survey
Multicultural youth aged 13-17 in the select media markets recruiting through social media and online panels - Pre-test online screener
Multicultural youth aged 13-17 in the select media markets recruiting through social media and online panels - Post-test online survey
Adults 18 and older in the United States - Screener and Consent Process-Pre-test outcome survey
Multicultural youth aged 13-17 in the select media markets recruiting through social media and online panels - Pre-test online survey
Multicultural youth aged 13-17 in the select media markets recruiting through social media and online panels - Post-test online screener
Longitudinal Cohort Second post-test evaluation survey
Cross-Sectional Cohort First post-test evaluation survey
Cross-Sectional Cohort Second post-test evaluation survey
Youth aged 12 to 17 in the United States - Screener and Consent Process- second post-test outcome survey
Youth aged 12 to 17 in the United States - Screener and Consent Process- Third post-test outcome survey
Adults 18 and older in the United States - Screener and Consent Process- second post-test outcome survey
Adults 18 and older in the United States - Screener and Consent Process- third post-test outcome survey
Longitudinal Cohort Third post-test evaluation survey
Cross-Sectional Cohort Second post-test evaluation survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	106,648	0	0	106,648	0	0
Annual Time Burden (Hours)	13,678	0	0	13,678	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New collection

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Annual Cost to Federal Government: $8,037,087

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/15/2015

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