LGBT young adults Outcome follow-up questionnaire (in person)

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 02 Survey Instrument Specs_FU6.docx Other-Follow Up
Attachment 13 Longitudinal Screener_FU6.docx Other-Screener
Attachment 14 Longitudinal Screener Inf Con_FU6.docx Other-Longitudinal Screener Inf Con
Attachment 06a New Participant Survey Informed Consent_FU6.docx Other- CrossSectional Survey Inf Con
Attachment 06b Returning Participant Survey Informed Consent_FU6.docx Other-Longitudinal Survey Inf Con

Information Collection (IC) Details

IC Title:	LGBT young adults Outcome follow-up questionnaire (in person)	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-Follow Up	Attachment 02 Survey Instrument Specs_FU6.docx	Yes	Yes	Fillable Fileable
Other-Screener	Attachment 13 Longitudinal Screener_FU6.docx	Yes	Yes	Fillable Printable
Other-Longitudinal Screener Inf Con	Attachment 14 Longitudinal Screener Inf Con_FU6.docx	Yes	Yes	Fillable Printable
Other- CrossSectional Survey Inf Con	Attachment 06a New Participant Survey Informed Consent_FU6.docx	Yes	Yes	Fillable Printable
Other-Longitudinal Survey Inf Con	Attachment 06b Returning Participant Survey Informed Consent_FU6.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: 5,378	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	5,378	1,113	4,265
Annual IC Time Burden (Hours)	3,587	741	2,846
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.