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

Generic Clearance for the Collection of Quantitative Data on Tobacco Products and Communications

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.