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

Evaluation of the Food and Drug Administration's 'Fresh Empire' Multicultural Youth Tobacco Prevention Campaign.

Documents and Forms

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

Information Collection (IC) Details

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

	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

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.