Adolescent Screener

Experimental Study on Warning Statements for Cigarette Graphic Health Warnings

Documents and Forms

Document Name Document Type
Appendix C_GWL Youth Assent_Clean.docx Other-Youht Assent
Appendix E_GWL Study Screener_Clean.docx Other-Study Screener

Information Collection (IC) Details

IC Title:	Adolescent 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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Youht Assent			Appendix C_GWL Youth Assent_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: 7,432	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	7,432	7,432
Annual IC Time Burden (Hours)	245	245
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.