Adult Screener

Experimental Study on Warning Statements for Cigarette Graphic Health Warnings

Documents and Forms

Document Name Document Type
Appendix A_GWL Adult Study Invitation E-mail Clean.docx Other-Invitation E-mail
Appendix B_GWL Parent Invite Permission Clean.docx Other-Parent Invite Permision
Appendix E_GWL Study Screener_Clean.docx Other-Study Screener

Information Collection (IC) Details

IC Title:	Adult Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Invitation E-mail	Appendix A_GWL Adult Study Invitation E-mail Clean.docx	Yes	Yes	Fillable Fileable
Other-Parent Invite Permision	Appendix B_GWL Parent Invite Permission Clean.docx	Yes	Yes	Fillable Fileable
Other-Study Screener	Appendix E_GWL Study Screener_Clean.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,412	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,412	12,412
Annual IC Time Burden (Hours)	410	410
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.