Information Collection

Youth Baseline Questionnaire (Male Rural Smokeless)

IC 208710 under ICR 201606-0910-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment 8_Study Description (male rural smokeless) 0910-0753.doc	Other-Study Description
Attachment 19_R. Email_reminder1 (male rural smokeless).doc	Other-Email Reminder 1 (male rural s
Attachment 20_R. Email_reminder2_(male rural smokeless).doc	Other-Email Reminder 2 (male rural s
Attachment 21_R. Email_reminder3 (male rural smokeless).doc	Other-Email Reminder 3 (male rural s
Attachment 6_R. Youth Assent (male rural smokeless)_REVISED.docx	Other-Youth Assent (male rural smoke
Attachment 14_R. Notifications (male rural smokeless).doc	Other-Notifications (male rural smok

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-Email Reminder 1 (male rural smokeless)	Attachment 19_R. Email_reminder1 (male rural smokeless).doc	Yes	No	Printable Only
Other-Email Reminder 2 (male rural smokeless)	Attachment 20_R. Email_reminder2_(male rural smokeless).doc	Yes	No	Printable Only
Other-Email Reminder 3 (male rural smokeless)	Attachment 21_R. Email_reminder3 (male rural smokeless).doc	Yes	No	Printable Only
Other-Notifications (male rural smokeless)	Attachment 14_R. Notifications (male rural smokeless).doc	No		Paper Only
Other-Youth Assent (male rural smokeless)	Attachment 6_R. Youth Assent (male rural smokeless)_REVISED.docx	Yes	Yes	Fillable Fileable
Other-Youth Baseline	Attachment 2_Youth Baseline Instrument (male rural smokeless) 0910-0753.docx	Yes	Yes	Fillable Fileable
Other-Study Description	Attachment 8_Study Description (male rural smokeless) 0910-0753.doc	No		Paper 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.