Adult Pretest and Main data collection

Experimental Study on Warning Statements for Cigarette Graphic Health Warnings

Documents and Forms

Document Name Document Type
Appendix D_GWL Adult Consent_Clean.docx Other-Adult Consent
Appendix F_GWL Instrument.docx Other-Study Instrument
Stimuli.pdf Other-Stimuli

Information Collection (IC) Details

IC Title:	Adult Pretest and Main data collection	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-Adult Consent	Appendix D_GWL Adult Consent_Clean.docx	Yes	Yes	Fillable Fileable
Other-Study Instrument	Appendix F_GWL Instrument.docx	Yes	Yes	Fillable Fileable
Other-Stimuli	Stimuli.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,735	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	1,735	1,735
Annual IC Time Burden (Hours)	434	434
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.