Information Collection

Att D2a_ Questionnaire (Wave B)

IC 217314 under ICR 201507-0920-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att D-2 Digital Media and Tobacco Outcomes Questionnaire (Waves A & B).pdf	Other-WORD/Screenshots
Digital Media Survey SS Part A_6 30 2015.docx SupSta A	IC Document
Digital Media Survey SS Part B_052615.docx SupSta B	IC Document
Att A-1. PHSA.doc Att A-1 Authorizing Legislation	IC Document
Att A-2. FSPTCA.PDF Att A-2 Auth Leg	IC Document
Att A-3. PPHF.pdf Att A-3 Auth Leg	IC Document
Att C. RTI IRB Non-research Determination.pdf Att C IRB	IC Document
Att B-1. Federal Register Notice.pdf Att B-1 FRN	IC Document
Att B-2. Public Comments.pdf Att B-2 Public Cmets	IC Document

IC Title:

Agency IC Tracking Number:

15MZ

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD/Screenshots			Att D-2 Digital Media and Tobacco Outcomes Questionnaire (Waves A & B).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SupSta A	Digital Media Survey SS Part A_6 30 2015.docx	07/01/2015
SupSta B	Digital Media Survey SS Part B_052615.docx	07/01/2015
Att A-1 Authorizing Legislation	Att A-1. PHSA.doc	07/01/2015
Att A-2 Auth Leg	Att A-2. FSPTCA.PDF	07/01/2015
Att A-3 Auth Leg	Att A-3. PPHF.pdf	07/01/2015
Att C IRB	Att C. RTI IRB Non-research Determination.pdf	07/01/2015
Att B-1 FRN	Att B-1. Federal Register Notice.pdf	07/01/2015
Att B-2 Public Cmets	Att B-2. Public Comments.pdf	07/01/2015

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