Information Collection

Media Tracking Screener

IC 208713 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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 4_E2a. Media Tracking Screener ExPECTT.docx	Other- Media Tracking Parent Permiss
Attachment 4_E2a2. Media Tracking Youth Assent.docx	Other-Media Tracking Youth Assent
Attachment 4_E2a3. Media Tracking Screener.docx	Other-Media Tracking Screener

IC Title:

Media Tracking Screener

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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-Media Tracking Youth Assent	Attachment 4_E2a2. Media Tracking Youth Assent.docx	Yes	Yes	Fillable Fileable
Other-Media Tracking Screener	Attachment 4_E2a3. Media Tracking Screener.docx	Yes	Yes	Fillable Fileable
Other- Media Tracking Parent Permission	Attachment 4_E2a. Media Tracking Screener ExPECTT.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60,000

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	Previously Approved
Annual Number of Responses for this IC	60,000	60,000
Annual IC Time Burden (Hours)	1,800	1,800
Annual IC Cost Burden (Dollars)	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.