General Population: Pilot test of Procedures in Bars

Food and Drug Administration's Research and Evaluation Survey for the Public Education Campaign on Tobacco among LGBT (RESPECT)

Documents and Forms

Document Name Document Type
Attachment 08 Script for Recruiting Intercept Participants_FU6.docx Other-Script for Recruiting Particip
Attachment 13 Longitudinal Screener_FU6.docx Other-Screener Informed Consent
Attachment 03 New Participant Screener_FU6.docx Other-Screener

Information Collection (IC) Details

IC Title:	General Population: Pilot test of Procedures in Bars	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-Script for Recruiting Participants	Attachment 08 Script for Recruiting Intercept Participants_FU6.docx	No		Printable Only
Other-Screener Informed Consent	Attachment 13 Longitudinal Screener_FU6.docx	Yes	Yes	Fillable Fileable
Other-Screener	Attachment 03 New Participant Screener_FU6.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: 27	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Previously Approved
Annual Number of Responses for this IC	27	27
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	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.