Information Collection

The Real Cost Campaign: Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent Youth Tobacco Use

IC 231334 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⚠️ Notice: This information collection may be referencing outdated material.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
A TRC Copy Testing Youth Screener.docx	Other-TRC Copy Testing Youth Screene
B TRC Copy Testing Adult Screener.docx	Other-TRC Copy Testing Adult Screene
C TRC Copy Testing Youth Questionnaire.docx	Other-TRC Copy Testing Youth Questio
D TRC Copy Testing Adult Questionnaire.docx	Other-TRC Copy Testing Adult Questio
E TRC Copy Testing Parental Notification and Opt-Out.docx	Other-TRC Copy Testing Parental Noti
F TRC Copy Testing Youth Assent Form.doc	Other-TRC Copy Testing Youth Assent
G TRC Copy Testing Adult Participant Consent Form.doc	Other-TRC Copy Testing Adult Partici
H TRC Copy Testing Stimuli.docx	Other-TRC Copy Testing Stimuli.
I TRC IRB Letter.pdf TRC IRB Letter	IC Document
TRC Copy Testing Part A.docx TRC Copy Testing Memo Part A	IC Document
TRC Copy Testing Part B.docx TRC Copy Testing Memo Part B	IC Document

IC Title:

The Real Cost Campaign: Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent 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-TRC Copy Testing Youth Screener	A TRC Copy Testing Youth Screener.docx	Yes	Yes	Fillable Fileable Signable
Other-TRC Copy Testing Adult Screener	B TRC Copy Testing Adult Screener.docx	Yes	Yes	Fillable Fileable Signable
Other-TRC Copy Testing Youth Questionnaire	C TRC Copy Testing Youth Questionnaire.docx	Yes	Yes	Fillable Fileable Signable
Other-TRC Copy Testing Adult Questionnaire	D TRC Copy Testing Adult Questionnaire.docx	Yes	Yes	Fillable Fileable Signable
Other-TRC Copy Testing Parental Notification and Opt-Out	E TRC Copy Testing Parental Notification and Opt-Out.docx	No		Printable Only
Other-TRC Copy Testing Youth Assent Form	F TRC Copy Testing Youth Assent Form.doc	Yes	Yes	Fillable Fileable Signable
Other-TRC Copy Testing Adult Participant Consent Form	G TRC Copy Testing Adult Participant Consent Form.doc	Yes	Yes	Fillable Fileable Signable
Other-TRC Copy Testing Stimuli.	H TRC Copy Testing Stimuli.docx	No		Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 17,000

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17,000	17,000
Annual IC Time Burden (Hours)	1,732	1,732
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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