Youth Mail Screener and Consent Process for Outcome Survey

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0788 can be found here:

Documents and Forms

Document Name Document Type
Attachment 2_Outcome Mail Screener.docx Other-Outcome Mail Screener
Attachment 5_Informed Consent and Assent.docx Other-Informed Consent and Assent
Attachment 5d_Informed Consent_Longitudinal Age 18_Web_FU3.docx Other-Longitudinal Web Consent 18+ Y
Attachment 5a_Parental Permission_Youth Assent_Longitudinal Age 12- 17_Household_FU3.docx Other-Longitudinal Informed Consent
Attachment 5b_Informed Consent_Longitudinal Age 18_Household_FU3.docx Other-Informed Consent Longitudinal

Information Collection (IC) Details

IC Title:	Youth Mail Screener and Consent Process for Outcome Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Outcome Mail Screener	Attachment 2_Outcome Mail Screener.docx	No		Paper Only
Other-Informed Consent and Assent	Attachment 5_Informed Consent and Assent.docx	No		Printable Only
Other-Longitudinal Web Consent 18+ Year Old Youth	Attachment 5d_Informed Consent_Longitudinal Age 18_Web_FU3.docx	Yes	Yes	Fillable Printable
Other-Longitudinal Informed Consent and Assent	Attachment 5a_Parental Permission_Youth Assent_Longitudinal Age 12- 17_Household_FU3.docx	No		Printable Only
Other-Informed Consent Longitudinal Age 18 Household	Attachment 5b_Informed Consent_Longitudinal Age 18_Household_FU3.docx	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,816	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	13,816	13,816
Annual IC Time Burden (Hours)	1,151	1,151
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.