Information Collection

Parent Of Youth Baseline Survey Participants

IC 208712 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⚠️ Notice: This information collection may be referencing outdated material.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 3_Parent Screener and Instrument (male rural smokeless) 0910-0753.docx	Other-Parent Screener
Attachment 3a_Parent Mail_Screener (male rural smokeless) 0910-0753.docx	Other-Parent Mail Screener
Rationale for Changes to Parent Survey (rural male smokeless 0910-0753.docx	Other-Rationale for Changes to Paren
Attachment 10_Lead Letter (male rural smokeless) 0910-0753.doc	Other-Lead Letter (Male Rural Smokel
Attachment 10_Lead Letter_ExPECTT 3 0910-0753.doc	Other-Lead Letter ExPECTT
Survey_invitation_email_ExPECTT 3 0910-0753.doc	Other-Survey Invitation Email ExPECT
Attachment 6_Permission Assent Consent (male rural smokeless) 0910-0753.doc	Other-Permission Assent Consent
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

IC Title:

Parent Of Youth Baseline Survey Participants

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-Parent Screener	Attachment 3_Parent Screener and Instrument (male rural smokeless) 0910-0753.docx	Yes	No	Printable Only
Other-Parent Mail Screener	Attachment 3a_Parent Mail_Screener (male rural smokeless) 0910-0753.docx	No		Paper Only
Other-Rationale for Changes to Parent Survey	Rationale for Changes to Parent Survey (rural male smokeless 0910-0753.docx	No		Printable Only
Other-Lead Letter (Male Rural Smokeless)	Attachment 10_Lead Letter (male rural smokeless) 0910-0753.doc	No		Paper Only
Other-Lead Letter ExPECTT	Attachment 10_Lead Letter_ExPECTT 3 0910-0753.doc	No		Paper Only
Other-Survey Invitation Email ExPECTT	Survey_invitation_email_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-Email Reminder 1	Email_reminder1_ExPECTT 3 0910-0753.doc	Yes	No	Printable Only
Other-Email Reminder 2	Email_reminder2_ExPECTT 3 0910-0753.doc	Yes	No	Printable Only
Other-Email Reminder 3	Email_reminder3_ExPECTT 3 0910-0753.doc	Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,342

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	3,342	3,342
Annual IC Time Burden (Hours)	568	568
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.