General Population Screener and Consent Process (Youth and Parent)

Evaluation of the Food and Drug Administration's General Market Youth Tobacco Prevention Campaign

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Attachment 3_E2a. Parent Guardian Tablet Screener ExPECTT.docx Other-Parent Guardian Tablet Screene
Attachment 3_E2b. Parent Guardian Mail Screener ExPECTT.docx Other-Parent Guardian Mail Screener
Attachment 3a_Parent Mail_Screener (male rural smokeless) 0910-0753.docx Other-Parent Mail_Screener (male rur
Attachment 6_E1b. Parent Permission ExPECTT.doc Other-Parent Permission ExPECTT
Attachment 6_E2b. Parent Permission ExPECTT.doc Other- Parent Permission ExPECTT (2)
Attachment 6_R. Parent Permission Forms (male rural smokeless).docx Other-Parent Permission (male rural

Information Collection (IC) Details

IC Title:	General Population Screener and Consent Process (Youth and Parent)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Parent Guardian Tablet Screener ExPECTT	Attachment 3_E2a. Parent Guardian Tablet Screener ExPECTT.docx	Yes	Yes	Fillable Fileable
Other-Parent Guardian Mail Screener ExPECTT	Attachment 3_E2b. Parent Guardian Mail Screener ExPECTT.docx	No		Paper Only
Other-Parent Mail_Screener (male rural smokeless)	Attachment 3a_Parent Mail_Screener (male rural smokeless) 0910-0753.docx	No		Paper Only
Other-Parent Permission ExPECTT	Attachment 6_E1b. Parent Permission ExPECTT.doc	No		Paper Only
Other- Parent Permission ExPECTT (2)	Attachment 6_E2b. Parent Permission ExPECTT.doc	No		Paper Only
Other-Parent Permission (male rural smokeless)	Attachment 6_R. Parent Permission Forms (male rural smokeless).docx	No		Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,880	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	30,880	30,880
Annual IC Time Burden (Hours)	5,250	5,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.