Digital Media and Tobacco Outcome Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Att C. RTI IRB Non-research Determination.pdf	Supplementary Document	Uploaded 2015-07-09	Repair queued
Att B-2. Public Comments.pdf	Supplementary Document	Uploaded 2015-07-09	Repair queued
Att B-1. Federal Register Notice.pdf	Supplementary Document	Uploaded 2015-07-09	Repair queued
Att A-3. PPHF.pdf	Supplementary Document	Uploaded 2015-07-09	Repair queued
Att A-2. FSPTCA.PDF	Supplementary Document	Uploaded 2015-07-09	Repair queued
Att A-1. PHSA.doc	Supplementary Document	Uploaded 2015-07-09	Repair queued
Digital Media Survey SS Part B_052615.docx	Supporting Statement B	Uploaded 2015-07-09	Repair queued
Digital Media Survey SS Part A_6 30 2015.docx	Supporting Statement A	Uploaded 2015-07-09	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
217314	Att D2a_ Questionnaire (Wave B)	Other-WORD/Screenshots	New
217313	Att D2 Ouestionnaire (Wave A)	Other-WORD/Screenshots	New
217311	Att D-1 Screening Questionnaire	Other-WORD	New

ICR Details

OMB Control No:	ICR Reference No: 201507-0920-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 15MZ
Title: Digital Media and Tobacco Outcome Survey
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 10/06/2015
	Date Received in OIRA: 07/13/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		12 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection will evaluate the impact of the digital advertising component of CDC's 2015 National Tobacco Prevention and Control Public Education Campaign.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 31 1 Name of Law: Family Smoking Prevention and Tobacco Control Act
   PL: Pub.L. 111 - 4 3602 Name of Law: Prevention of Chronic Disease and Improving Public Health
  

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 6725	02/06/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 39437	07/09/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Att D2 Ouestionnaire (Wave A)
Att D2a_ Questionnaire (Wave B)
Att D-1 Screening Questionnaire

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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: This is a NEW collection request for a new OMB Control Number.

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Annual Cost to Federal Government: $148,950

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]? Yes

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: 07/13/2015

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