Information Collection

Wave 3 Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent Multicultural Youth Tobacco Use

IC 230877 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⚠️ Notice: This information collection may be referencing outdated material.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 - Parental Opt-Out Form.docx	Other-Parental Opt-Out Form
Attachment D - Participant Youth Assent-Consent Form.docx	Other-Participant Youth Assent-Conse
Attachment E - Parent_Participant Electronic Communications.docx	Other-Parent_Participant Electronic
Attachment F - Video Ad Stimuli.pdf	Other-Video Ad Stimuli
FE CT Wave 3_OMB SS Part A.docx Generic Memo SS Part A	IC Document
FE CT Wave 3_OMB SS Part B.docx Generic Memo Part B	IC Document
Attachment G - IRB Approval Letter.pdf IRB Approval Letter	IC Document

IC Title:

Wave 3 Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent Multicultural Youth Tobacco Use

Agency IC Tracking Number:

CTP

IC Status: New

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-Screener	Attachment A - Screener.docx	Yes	Yes	Fillable Fileable Signable
Other-Questionnaire	Attachment B - Questionnaire.docx	Yes	Yes	Fillable Fileable Signable
Other-Parental Opt-Out Form	Attachment C - Parental Opt-Out Form.docx	No		Paper Only
Other-Participant Youth Assent-Consent Form	Attachment D - Participant Youth Assent-Consent Form.docx	No		Paper Only
Other-Parent_Participant Electronic Communications	Attachment E - Parent_Participant Electronic Communications.docx	Yes	Yes	Fillable Fileable Signable
Other-Video Ad Stimuli	Attachment F - Video Ad Stimuli.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,695

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,695	9,695
Annual IC Time Burden (Hours)	1,376	1,376
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Memo SS Part A	FE CT Wave 3_OMB SS Part A.docx	03/30/2018
Generic Memo Part B	FE CT Wave 3_OMB SS Part B.docx	03/30/2018
IRB Approval Letter	Attachment G - IRB Approval Letter.pdf	03/30/2018

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