Information Collection

Cross-Sectional Youth Refresher Sample, Post-test and Assent/Consent Process - Outcome Surveys 1-5

IC 215945 under ICR 201901-0910-003 · OMB 0910-0788.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 01_EFECT_Post_Campaign_Instrument_FU5.docx	Other-Post Campaign Instrument
Attachment 17_Verification Call Script_Age 13-17_FU5.docx	Other-Verification Call Script
Attachment 05b_Informed Consent_Longitudinal Age 18_Household_FU5.docx	Other-Informed Consent Longitudinal
Attachment 05e_Youth Assent_Cross Sectional Age 15 - 17_Social Media_Web_FU5.docx	Other-Youth Assent Cross Sectional A
Attachment 05f_Youth Assent_Cross Sectional Age 13 - 14_Social Media_Web_FU5.docx	Other-Youth Assent Cross Sectional A

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Post Campaign Instrument	Attachment 01_EFECT_Post_Campaign_Instrument_FU5.docx	Yes	Yes	Fillable Fileable
Other-Verification Call Script	Attachment 17_Verification Call Script_Age 13-17_FU5.docx	No		Printable Only
Other-Informed Consent Longitudinal Age 18 (Household)	Attachment 05b_Informed Consent_Longitudinal Age 18_Household_FU5.docx	No		Paper Only
Other-Youth Assent Cross Sectional Age 15 - 17 Social Media (Web)	Attachment 05e_Youth Assent_Cross Sectional Age 15 - 17_Social Media_Web_FU5.docx	Yes	Yes	Fillable Printable
Other-Youth Assent Cross Sectional Age 13 - 14 Social Media (Web)	Attachment 05f_Youth Assent_Cross Sectional Age 13 - 14_Social Media_Web_FU5.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: 4,920

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	Previously Approved
Annual Number of Responses for this IC	4,920	4,920
Annual IC Time Burden (Hours)	3,690	3,690
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.