Information Collection

Parent Of Youth Baseline Survey Participants

IC 208712 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⚠️ Notice: This information collection may be referencing outdated material.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:

2022-04-07 - No material or nonsubstantive change to a currently approved collection
2020-09-23 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 21_E1. Email_reminder3_ExPECTT.doc	Other-Email Reminder 3 ExPECTT
Attachment 3_Parent Screener and Instrument (male rural smokeless) 0910-0753.docx	Other-Parent Screener and Instrument
Attachment 10_R. Lead Letter (male rural smokeless).doc	Other-ead Letter (male rural smokele
Attachment 10_E1. Lead Letter ExPECTT.doc	Other-Lead Letter ExPECTT 1
Attachment 10_E2. Lead Letter ExPECTT.doc	Other-Lead Letter ExPECTT 2
Attachment 18_E1. Survey_invitation_email_ExPECTT.doc	Other-Survey Invitation Email ExPECT
Attachment 18_R. Survey Invitation Email (male rural smokeless).doc	Other-Survey Invitation Email (male
Attachment 19_E1. Email_reminder1_ExPECTT.doc	Other-Email Reminder 1 ExPECTT
Attachment 20_E1. mail_reminder2_ExPECTT.doc	Other-Mail Reminder 2ExPECTT
Attachment 3_E2c. Parent Guardian Instrument ExPECTT.doc	Other-Parent Guardian Instrument ExP
Attachment 7_E2. Introduction to Study.doc	Other-Introduction to Study
Attachment 8_E2. Study Description.doc	Other-Study Description
Attachment 11_E2. Q&As about the ExPECTT Evaluation.doc	Other-Q&As about the ExPECTT Evaluat
Attachment 11_R. Questions and Answers (male rural smokeless).doc	Other-Questions and Answers (male ru
Attachment 12_E2. Telephone Verification Survey ExPECTT.doc	Other-Telephone Verification Survey
Attachment 12_R. Field Interviewer Verification (male rural smokeless).docx	Other-Field Interviewer Verification
Attachment 13_E2. Notifications ExPECTT.doc	Other-Notifications ExPECTT
Attachment 15_E1. Panel Maintenance ExPECTT.docx	Other-Panel Maintenance ExPECTT
Attachment 15_E2. Panel Maintenance Letter ExPECTT.docx	Other-Panel Maintenance Letter ExPEC
Attachment 15_R. Panel Maintenance Letter (male rural smokeless).docx	Other-Panel Maintenance Letter (male
Attachment 16_R. Panel_Maint_Update_Form (male rural smokeless).docx	Other-Panel_Maint_Update_Form (male

Information Collection (IC) Details

View Information Collection (IC)

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-Panel_Maint_Update_Form (male rural smokeless)	Attachment 16_R. Panel_Maint_Update_Form (male rural smokeless).docx	No		Paper Only
Other-Email Reminder 3 ExPECTT	Attachment 21_E1. Email_reminder3_ExPECTT.doc	Yes	No	Printable Only
Other-Parent Screener and Instrument (male rural smokeless)	Attachment 3_Parent Screener and Instrument (male rural smokeless) 0910-0753.docx	Yes	Yes	Fillable Fileable
Other-ead Letter (male rural smokeless)	Attachment 10_R. Lead Letter (male rural smokeless).doc	No		Paper Only
Other-Lead Letter ExPECTT 1	Attachment 10_E1. Lead Letter ExPECTT.doc	No		Paper Only
Other-Lead Letter ExPECTT 2	Attachment 10_E2. Lead Letter ExPECTT.doc	No		Paper Only
Other-Survey Invitation Email ExPECTT	Attachment 18_E1. Survey_invitation_email_ExPECTT.doc	No		Printable Only
Other-Survey Invitation Email (male rural smokeless)	Attachment 18_R. Survey Invitation Email (male rural smokeless).doc	No		Printable Only
Other-Email Reminder 1 ExPECTT	Attachment 19_E1. Email_reminder1_ExPECTT.doc	Yes	No	Printable Only
Other-Mail Reminder 2ExPECTT	Attachment 20_E1. mail_reminder2_ExPECTT.doc	No		Paper Only
Other-Parent Guardian Instrument ExPECTT	Attachment 3_E2c. Parent Guardian Instrument ExPECTT.doc	Yes	Yes	Fillable Fileable
Other-Introduction to Study	Attachment 7_E2. Introduction to Study.doc	Yes	No	Printable Only
Other-Study Description	Attachment 8_E2. Study Description.doc	No		Printable Only
Other-Q&As about the ExPECTT Evaluation	Attachment 11_E2. Q&As about the ExPECTT Evaluation.doc	No		Paper Only
Other-Questions and Answers (male rural smokeless)	Attachment 11_R. Questions and Answers (male rural smokeless).doc	Yes	No	Printable Only
Other-Telephone Verification Survey ExPECTT	Attachment 12_E2. Telephone Verification Survey ExPECTT.doc	No		Printable Only
Other-Field Interviewer Verification (male rural smokeless)	Attachment 12_R. Field Interviewer Verification (male rural smokeless).docx	No		Printable Only
Other-Notifications ExPECTT	Attachment 13_E2. Notifications ExPECTT.doc	No		Paper Only
Other-Panel Maintenance ExPECTT	Attachment 15_E1. Panel Maintenance ExPECTT.docx	No		Paper Only
Other-Panel Maintenance Letter ExPECTT	Attachment 15_E2. Panel Maintenance Letter ExPECTT.docx	No		Paper Only
Other-Panel Maintenance Letter (male rural smokeless)	Attachment 15_R. Panel Maintenance Letter (male rural smokeless).docx	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,009

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,009	2,667	3,342
Annual IC Time Burden (Hours)	1,022	454	568
Annual IC Cost Burden (Dollars)	0	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.