Information Collection

Creative Concept Testing Designed to Prevent Youth ENDS Use in General and Hip Hop Audiences

IC 236392 under ICR 201805-0910-001 · OMB 0910-0796.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0796 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
App A.docx	Other-Parental Permission Form
App B.docx	Other-Youth Assent Form
App C1.docx	Other-Screener
App C2.docx	Other-Screener Contact Sheet
App D1.doc	Other-Discussion Guide
App D2.docx	Other-Products Board
App E.docx	Other-Concept Rating Sheet
App F.docx	Other-Concept Ranking Sheet
Memo.docx Justification Memo	IC Document
Focus Group Stimuli sources w image_OMB R&E Clean.docx Focus Group Stimuli	IC Document

IC Title:

Creative Concept Testing Designed to Prevent Youth ENDS Use in General and Hip Hop Audiences

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 Contact Sheet	App C2.docx	Yes	Yes	Fillable Printable
Other-Discussion Guide	App D1.doc	No		Printable Only
Other-Products Board	App D2.docx	Yes	No	Fillable Printable
Other-Concept Rating Sheet	App E.docx	No		Paper Only
Other-Concept Ranking Sheet	App F.docx	No		Paper Only
Other-Parental Permission Form	App A.docx	Yes	Yes	Fillable Printable
Other-Youth Assent Form	App B.docx	Yes	Yes	Fillable Printable
Other-Screener	App C1.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,620

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,620	1,620
Annual IC Time Burden (Hours)	649	649
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification Memo	Memo.docx	06/10/2019
Focus Group Stimuli	Focus Group Stimuli sources w image_OMB R&E Clean.docx	06/28/2019

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