Information Collection

Youth 1st, 2nd, and; 3rd (Male, Rural Smokeless) follow up questionnaire

IC 208711 under ICR 201711-0910-003 · OMB 0910-0753.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0753 can be found here:

2022-04-07 - No material or nonsubstantive change to a currently approved collection
2020-09-23 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 2_R. Youth Followup 3 Instrument (male rural smokeless).docx	Other-Youth Followup1 Instrument (ma
Attachment 6_R2. Youth Assent (male rural smokeless).docx	Other-Youth Assent (male rural smoke
Attachment 23_R. Incentive Letter (male rural smokeless).docx	Other- Incentive Letter (male rural
Attachment 24_R. Consent Forms 18 (male rural smokeless).docx	Other-Consent Forms 18 (male rural s
Attachment 25_R. Lead Letter 18 (male rural smokeless).docx	Other-Lead Letter 18 (male rural smo
Attachment 26_R. QA about the Evaluation 18 (male rural smokeless).docx	Other-Questions and Answers about th
Attachment 27_R. Field Interviewer Verification - 18 (male rural smokeless).docx	Other- Field Interviewer Verificatio
Attachment 28_R. Survey Invitation Email - 18 (male rural smokeless).docx	Other-Survey Invitation Email - 18 (
Attachment 29_R. Email Reminder 1 - 18 (male rural smokeless).docx	Other-Email Reminder 1 - 18 (male ru
Attachment 30_R. Email Reminder 2 -18 (male rural smokeless).docx	Other-Email Reminder 2 -18 (male rur
Attachment 32_R. Panel Maintenance Letter - 18 (male rural smokeless).docx	Other-Panel Maintenance Letter - 18
Attachment 33_R. Panel Maintenance Update Form - 18 (male rural smokeless).docx	Other- Panel Maintenance Update Form
Attachment 34_R. No Response Reminder Letter - 18 (male rural smokeless).docx	Other-No Response Reminder Letter -
Attachment 35_R. Panel Maintenance Email - 18 (male rural smokeless).docx	Other-Panel Maintenance Email - 18 (
Attachment 2_R. Youth Followup 4 Instrument (male rural smokeless).docx	Other-Youth Followup (1) 4 Instrumen
Attachment 31_R. Email Reminder 3 - 18 (male rural smokeless).docx	Other-Email Reminder 3 - 18 (male ru
Attachment 36_R. Post_Card_Reminder_Notice.docx	Other-Post Card Reminder Notice

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Youth 1st, 2nd, and; 3rd (Male, Rural Smokeless) follow up questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Consent Forms 18 (male rural smokeless)	Attachment 24_R. Consent Forms 18 (male rural smokeless).docx	Yes	Yes	Fillable Fileable
Other-Lead Letter 18 (male rural smokeless)	Attachment 25_R. Lead Letter 18 (male rural smokeless).docx	Yes	Yes	Fillable Fileable
Other-Questions and Answers about the Evaluation 18 (male rural smokeless)	Attachment 26_R. QA about the Evaluation 18 (male rural smokeless).docx	Yes	Yes	Fillable Fileable
Other- Field Interviewer Verification - 18 (male rural smokeless)	Attachment 27_R. Field Interviewer Verification - 18 (male rural smokeless).docx	No		Fillable Printable
Other-Survey Invitation Email - 18 (male rural smokeless)	Attachment 28_R. Survey Invitation Email - 18 (male rural smokeless).docx	No		Printable Only
Other-Email Reminder 1 - 18 (male rural smokeless)	Attachment 29_R. Email Reminder 1 - 18 (male rural smokeless).docx	No		Printable Only
Other-Email Reminder 2 -18 (male rural smokeless)	Attachment 30_R. Email Reminder 2 -18 (male rural smokeless).docx	No		Printable Only
Other-Panel Maintenance Letter - 18 (male rural smokeless)	Attachment 32_R. Panel Maintenance Letter - 18 (male rural smokeless).docx	No		Paper Only
Other- Panel Maintenance Update Form - 18 (male rural smokeless)	Attachment 33_R. Panel Maintenance Update Form - 18 (male rural smokeless).docx	No		Paper Only
Other-No Response Reminder Letter - 18 (male rural smokeless)	Attachment 34_R. No Response Reminder Letter - 18 (male rural smokeless).docx	No		Paper Only
Other-Panel Maintenance Email - 18 (male rural smokeless)	Attachment 35_R. Panel Maintenance Email - 18 (male rural smokeless).docx	Yes	No	Printable Only
Other-Youth Followup (1) 4 Instrument (male rural smokeless	Attachment 2_R. Youth Followup 4 Instrument (male rural smokeless).docx	Yes	Yes	Fillable Fileable Signable
Other-Email Reminder 3 - 18 (male rural smokeless)	Attachment 31_R. Email Reminder 3 - 18 (male rural smokeless).docx	Yes	No	Printable Only
Other-Post Card Reminder Notice	Attachment 36_R. Post_Card_Reminder_Notice.docx	No		Paper Only
Other-Youth Followup1 Instrument (male rural smokeless)	Attachment 2_R. Youth Followup 3 Instrument (male rural smokeless).docx	Yes	Yes	Fillable Fileable
Other-Youth Assent (male rural smokeless)	Attachment 6_R2. Youth Assent (male rural smokeless).docx	Yes	Yes	Fillable Fileable
Other- Incentive Letter (male rural smokeless)	Attachment 23_R. Incentive Letter (male rural smokeless).docx	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,954

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,954	673	1,281
Annual IC Time Burden (Hours)	1,466	505	961
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.