Youth Online Screener– Outcome Survey

Evaluation of the Food and Drug Administration's 'Fresh Empire' Multicultural Youth Tobacco Prevention Campaign.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0788 can be found here:

Documents and Forms

Document Name Document Type
Attachment 5c_Parental Permission_Youth Assent_Longitudinal Age 12-17_Web_FU3.docx Other-Longitudinal Web Consent and A
Attachment 5d_Informed Consent_Longitudinal Age 18_Web_FU3.docx Other-Longitudinal Web Consent 18+ Y
Attachment 5e_Youth Assent_Cross Sectional Age 15 - 17_Social Media_Web_FU3.docx Other-Cross Sectional Social Media_S
Attachment 5f_Youth Assent_Cross Sectional Age 13 - 14_Social Media_Web_FU3.docx Other-Youth Assent Cross Sectional A
Attachment 5g_Youth Assent_Longitudinal Age 13 - 17_Social Media_Web_FU3.docx Other-Youth Assent Longitudinal Age
Attachment 5i_Youth Assent_Longitudinal Age 15 - 17_Social Media_Permission Waived_Web_FU3.docx Other-Youth Assent Longitudinal Age
Attachment 3_Outcome Web Screener_FU3.docx Other-Outcome Web Screener

Information Collection (IC) Details

IC Title:	Youth Online Screener– Outcome Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Longitudinal Web Consent and Assent	Attachment 5c_Parental Permission_Youth Assent_Longitudinal Age 12-17_Web_FU3.docx	Yes	Yes	Printable Only
Other-Longitudinal Web Consent 18+ Year Old Youth	Attachment 5d_Informed Consent_Longitudinal Age 18_Web_FU3.docx	Yes	Yes	Printable Only
Other-Cross Sectional Social Media_Snowball 15+ Youth	Attachment 5e_Youth Assent_Cross Sectional Age 15 - 17_Social Media_Web_FU3.docx	Yes	Yes	Fillable Fileable
Other-Youth Assent Cross Sectional Age 13 - 14 Social Media Web	Attachment 5f_Youth Assent_Cross Sectional Age 13 - 14_Social Media_Web_FU3.docx	Yes	Yes	Fillable Fileable
Other-Youth Assent Longitudinal Age 13 - 17 Social Media Web	Attachment 5g_Youth Assent_Longitudinal Age 13 - 17_Social Media_Web_FU3.docx	Yes	Yes	Fillable Fileable
Other-Youth Assent Longitudinal Age 15 - 17 Social Media Permission Waived Web	Attachment 5i_Youth Assent_Longitudinal Age 15 - 17_Social Media_Permission Waived_Web_FU3.docx	Yes	Yes	Fillable Fileable
Other-Outcome Web Screener	Attachment 3_Outcome Web Screener_FU3.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: 40,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	40,000	8,000	32,000
Annual IC Time Burden (Hours)	3,332	666	2,666
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.