Information Collection

Media Tracking Questionnaires 1st, 2nd and; 3rd

IC 208714 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⚠️ Notice: This information collection may be referencing outdated material.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 4_Media Tracking Instrument ExPECTT 3 0910-0753.docx	Other-Media Tracking ExPECTT
Rationale for Changes to ExPECTT 3 Media Tracking Instrument 0910-0753.docx	Other-Rationale for Changes to ExpEC
Attachment 2_Youth Follow-up Instrument ExPECTT 3 0910-0753.doc	Other-Youth Follow-up ExPECTT
Rationale for Changes to ExPECTT 3 Instrument 0910-0753.docx	Other-Rational for Changes to ExPECT
0 Contents of OMB Change Request for ExPECTT Second Follow Up.doc Contents of change request	IC Document

IC Title:

Media Tracking Questionnaires 1st, 2nd and; 3rd

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-Media Tracking ExPECTT	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
Other-Youth Follow-up ExPECTT	Attachment 2_Youth Follow-up Instrument ExPECTT 3 0910-0753.doc	Yes	Yes	Fillable Fileable
Other-Rational for Changes to ExPECTT	Rationale for Changes to ExPECTT 3 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: 3,999

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	3,999	3,999
Annual IC Time Burden (Hours)	2,001	2,001
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Contents of change request	0 Contents of OMB Change Request for ExPECTT Second Follow Up.doc	03/04/2015

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