Information Collection

Nicotine Education Project: Qualitative Study to Gain Insights from Adult Current and Former Smokers to Educate the General Public about Changing Nicotine Standards

IC 237278 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⚠️ Notice: This information collection may be referencing outdated material.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
Appendix A_Consent Form.docx	Other-Consent Form
Appendix B_Screener_OMBEditClean 11.20.19.docx	Other-Screener
Appendix C_Screener Contact Sheet.docx	Other-Screener Contact Sheet
Appendix D_Moderator Guide Clean 11.12.19.docx	Other-Moderator Guide
Appendix E1 Check in Survey Current Smokers.docx	Other-Check in Survey Current Smoker
Appendix E2.docx	Other-Check in Survey Fomer Smokers
Appendix E3.docx	Other-Check in Survey Fomer Smokers
Appendix F_Check Out Form.docx	Other-Check Out Form
OMB Memo Clean 11 20 2019.docx OMB Justification Memo	IC Document
Nicotine Education Project_Advarra IRB.pdf IRB Approval	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Nicotine Education Project: Qualitative Study to Gain Insights from Adult Current and Former Smokers to Educate the General Public about Changing Nicotine Standards

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?	Electronic Capability
Other-Screener	Appendix B_Screener_OMBEditClean 11.20.19.docx	No	Paper Only
Other-Moderator Guide	Appendix D_Moderator Guide Clean 11.12.19.docx	No	Paper Only
Other-Consent Form	Appendix A_Consent Form.docx	No	Fillable Printable
Other-Screener Contact Sheet	Appendix C_Screener Contact Sheet.docx	No	Printable Only
Other-Check in Survey Current Smokers	Appendix E1 Check in Survey Current Smokers.docx	No	Paper Only
Other-Check in Survey Fomer Smokers Nicotine	Appendix E2.docx	No	Paper Only
Other-Check in Survey Fomer Smokers No Nicotine	Appendix E3.docx	No	Paper Only
Other-Check Out Form	Appendix F_Check Out Form.docx	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 810

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	810	810
Annual IC Time Burden (Hours)	488	488
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Justification Memo	OMB Memo Clean 11 20 2019.docx	11/20/2019
IRB Approval	Nicotine Education Project_Advarra IRB.pdf	08/08/2019

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