Evaluation of the Food and Drug Administration's 'Fresh Empire' Multicultural Youth Tobacco Prevention Campaign.

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0788 Early Bird Incentive Clarification.docx	Supplementary Document	Uploaded 2017-09-19	Available
0910-0788 Change request memo 8.11.17.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-08-15	Available
0910-0788 Summary of Changes to EFECT Instrument for FU3.docx	Supplementary Document	Uploaded 2017-08-15	Available
0910-0788 SS OMB_Part B_FU2.docx	Supporting Statement B	Uploaded 2017-08-15	Available
0910-0788 SS OMB_Part A_FU2.docx	Supporting Statement A	Uploaded 2017-08-15	Available
Attachment 1a_Summary of Changes to Post-Campaign Instrument.docx	Supplementary Document	Uploaded 2017-01-03	Available
Change Request memo for FDA EFECT Second Follow-up 0910-0788.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-01-03	Available
Attachment 15_Interview Incentive Receipt_FU3.docx	Supplementary Document	Uploaded 2017-08-15	Available
Attachment 14b_Questions and Answers Fact Sheet (Online).docx	Supplementary Document	Uploaded 2017-08-15	Available
Attachment 14a_Questions and Answers Fact Sheet (Household).docx	Supplementary Document	Uploaded 2017-08-15	Available
Attachment 12 _Sorry I Missed You Card .docx	Supplementary Document	Uploaded 2016-03-22	Available
Attachment 9_ Reminder Postcard.docx	Supplementary Document	Uploaded 2016-03-22	Available
Attachment 6_Study Description_FU3.docx	Supplementary Document	Uploaded 2017-08-15	Available
Attachment 7_Non Disclosure Agreement.pdf	Supplementary Document	Uploaded 2016-03-22	Available
Attachment 4_ Incentive Lit Review.doc	Supplementary Document	Uploaded 2016-03-22	Available
Attachment 3a_Social_Media_Ads.docx	Supplementary Document	Uploaded 2017-01-03	Available
Change Request memo for FDA EFECT First Follow-up 0910-0788.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2016-03-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215947	Youth Screener and Consent for Online Outcome Survey	Other-Longitudinal Web Consent and Assent	Modified
215945	Cross-Sectional Cohort Youth Post-Test Outcome Survey	Other-Post Campaign Instrument	Modified
215944	Longitudinal Cohort Youth Post-Test Outcome Survey	Other-Post Campaign Instrument.	Modified
215943	Youth Pre-Test Outcome Survey	Other-Post Campaign Instrument	Modified
215942	Adult Mail Screener and Consent Process for Outcome Survey	Other-Outcome Mail Screener	Modified
215941	Youth Mail Screener and Consent Process for Outcome Survey	Other-Outcome Mail Screener	Modified

ICR Details

OMB Control No: 0910-0788	ICR Reference No: 201708-0910-012
Status: Historical Active	Previous ICR Reference No: 201701-0910-001
Agency/Subagency: HHS/FDA	Agency Tracking No: CTP
Title: Evaluation of the Food and Drug Administration's 'Fresh Empire' Multicultural Youth Tobacco Prevention Campaign.
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/20/2017
	Date Received in OIRA: 08/15/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	05/31/2018	05/31/2018
Responses	75,105	0	74,950
Time Burden (Hours)	10,322	0	10,206
Cost Burden (Dollars)	0	0	0

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Abstract: The Food and Drug Administration (FDA) requests Office of Management and Budget (OMB) approval to conduct in-person and Web-based surveys of multicultural youth in the United States, as the Evaluation of the Fresh Empire Campaign on Tobacco (EFECT). These surveys will be fielded for purposes of evaluating FDA’s Fresh Empire public education campaign for multicultural youth 12 to 17 years old. The primary outcome evaluation will consist of a pre-test survey and cross-sectional post-test surveys with an embedded longitudinal cohort in campaign and control cities beginning approximately 6 months following the campaign launch. Data from this evaluation will be used to gauge campaign awareness and examine the statistical relationships between exposure to the campaign and changes in outcome variables of interest.

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Authorizing Statute(s): PL: Pub.L. 111 - 31 1003(d)(2)(D) Name of Law: Federal Food, Drug, and Cosmetic Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 230	01/05/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 19673	04/13/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Youth Mail Screener and Consent Process for Outcome Survey
Cross-Sectional Cohort Youth Post-Test Outcome Survey
Youth Pre-Test Outcome Survey
Longitudinal Cohort Youth Post-Test Outcome Survey
Youth Screener and Consent for Online Outcome Survey
Adult Mail Screener and Consent Process for Outcome Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	75,105	74,950	0	0	155	0
Annual Time Burden (Hours)	10,322	10,206	0	0	116	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $8,037,087

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/15/2017

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