Information Collection

LGBT Campaign: Wave 1B Online Quantitative Study Designed to Prevent Young Adult Tobacco Use

IC 225031 under ICR 201802-0910-012 · OMB 0910-0810.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0810 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A_Screener (+++).docx	Other-Screener
Attachment B_Questionnaire (+++).docx	Other-Questionnaire
Attachment C_Informed Consent Form (+++).docx	Other-Informed Consent Form
Attachment D_Reminder Emails (+++).docx	Other-Reminder Emails
Attachment E_Social Media Ads (++).pdf	Other-Social Media Ads
Attachment F_Video Ad Stimuli.doc	Other-Video Ad Stimuli
LGBT Campaign GenIC_Part A_Quantitative Supporting Statement (TFL)_OMB+++.docx Supporting Statement A	IC Document
Part B_Quantitative Supporting Statement (TFL) (+++).docx Supporting Statement B	IC Document
Attachment G_IRB Letter.pdf IRB Letter	IC Document

IC Title:

LGBT Campaign: Wave 1B Online Quantitative Study Designed to Prevent Young Adult Tobacco Use

Agency IC Tracking Number:

CTP

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-Reminder Emails	Attachment D_Reminder Emails (+++).docx	Yes	No	Printable Only
Other-Social Media Ads	Attachment E_Social Media Ads (++).pdf	Yes	No	Printable Only
Other-Video Ad Stimuli	Attachment F_Video Ad Stimuli.doc	Yes	No	Printable Only
Other-Screener	Attachment A_Screener (+++).docx	Yes	Yes	Fillable Fileable
Other-Questionnaire	Attachment B_Questionnaire (+++).docx	Yes	Yes	Fillable Fileable
Other-Informed Consent Form	Attachment C_Informed Consent Form (+++).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: 3,150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	3,150	3,150
Annual IC Time Burden (Hours)	427	427
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	LGBT Campaign GenIC_Part A_Quantitative Supporting Statement (TFL)_OMB+++.docx	01/04/2017
Supporting Statement B	Part B_Quantitative Supporting Statement (TFL) (+++).docx	01/04/2017
IRB Letter	Attachment G_IRB Letter.pdf	01/04/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.