Information Collection

General Population Screener and Consent Process (Youth and Parent)

IC 208707 under ICR 201707-0910-016 · 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⚠️ Notice: This information collection may be referencing outdated material.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_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

IC Title:

General Population Screener and Consent Process (Youth and Parent)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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 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 %

table that charts list of burden
	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

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.