General population – outcome screener (social media)

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 05 CrossSectional Screener Inf Con_FU6.docx Other-Screener Informed Consent
Attachment 03 New Participant Screener_FU6.docx Other-Screener

Information Collection (IC) Details

IC Title:	General population – outcome screener (social media)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener Informed Consent			Attachment 05 CrossSectional Screener Inf Con_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: 3,539	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,539	456	3,083
Annual IC Time Burden (Hours)	294	38	256
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.