Information Collection

Youth Baseline Questionnaire (Male Rural Smokeless)

IC 208710 under ICR 201512-0910-002 · OMB 0910-0753.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0753 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 2_Youth Baseline Instrument (male rural smokeless) 0910-0753.docx	Other-Youth Baseline
Rationale for Changes to Baseline Instrument (rural male smokeless) 0910-0753.docx	Other-Rationale for Changes to Basel
Attachment 8_Study Description (male rural smokeless) 0910-0753.doc	Other-Study Description
Email_reminder1_ExPECTT 3 0910-0753.doc	Other-Email Reminder 1
Email_reminder2_ExPECTT 3 0910-0753.doc	Other-Email Reminder 2
Email_reminder3_ExPECTT 3 0910-0753.doc	Other-Email Reminder 3
Attachment 6_Permission Assent Consent (male rural smokeless) 0910-0753.doc	Other-Permission Assent Consent
Attachment 6c_Youth Assent under 18 ExPECTT 3 0910-0753.doc	Other-Youth Assent Under 18 ExPECTT
Attachment 4_Media Tracking Instrument ExPECTT 3 0910-0753.docx	Other-Media Tracking
Rationale for Changes to ExPECTT 3 Media Tracking Instrument 0910-0753.docx	Other-Rationale for Changes to ExPEC

IC Title:

Youth Baseline Questionnaire (Male Rural Smokeless)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Youth Baseline	Attachment 2_Youth Baseline Instrument (male rural smokeless) 0910-0753.docx	Yes	Yes	Fillable Fileable
Other-Rationale for Changes to Baseline	Rationale for Changes to Baseline Instrument (rural male smokeless) 0910-0753.docx	No		Printable Only
Other-Study Description	Attachment 8_Study Description (male rural smokeless) 0910-0753.doc	No		Paper Only
Other-Email Reminder 1	Email_reminder1_ExPECTT 3 0910-0753.doc	Yes	Yes	Fillable Fileable
Other-Email Reminder 2	Email_reminder2_ExPECTT 3 0910-0753.doc	Yes	Yes	Fillable Fileable
Other-Email Reminder 3	Email_reminder3_ExPECTT 3 0910-0753.doc	Yes	Yes	Fillable Fileable
Other-Permission Assent Consent	Attachment 6_Permission Assent Consent (male rural smokeless) 0910-0753.doc	No		Paper Only
Other-Youth Assent Under 18 ExPECTT	Attachment 6c_Youth Assent under 18 ExPECTT 3 0910-0753.doc	No		Paper Only
Other-Media Tracking	Attachment 4_Media Tracking Instrument ExPECTT 3 0910-0753.docx	Yes	Yes	Fillable Fileable
Other-Rationale for Changes to ExPECTT Media Tracking	Rationale for Changes to ExPECTT 3 Media Tracking Instrument 0910-0753.docx	No		Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 656

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	Previously Approved
Annual Number of Responses for this IC	656	656
Annual IC Time Burden (Hours)	328	328
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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