Youth Online Screener– Outcome Survey

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

Documents and Forms

Document Name Document Type
Attachment 05c_Parental Permission_Youth Assent_Longitudinal Age 12-17_Web_FU5.docx Other-Longitudinal Web Consent and A
Attachment 05d_Informed Consent_Longitudinal Age 18_Web_FU5.docx Other-Longitudinal Web Consent 18+ Y
Attachment 05e_Youth Assent_Cross Sectional Age 15 - 17_Social Media_Web_FU5.docx Other-Cross Sectional Social Media_S
Attachment 05f_Youth Assent_Cross Sectional Age 13 - 14_Social Media_Web_FU5.docx Other-Youth Assent Cross Sectional A
Attachment 05g_Youth Assent_Longitudinal Age 13 - 17_Social Media_Web_FU5.docx Other-Youth Assent Longitudinal Age
Attachment 05i_Youth Assent_ Age 15 - 17_Social Media_Permission Waived_Web_FU5.docx Other-Youth Assent Longitudinal Age
Attachment 03_EFECT_Outcome_Web_Screener_FU5.docx Other-Outcome Web Screener

Information Collection (IC) Details

IC Title:	Youth Online Screener– Outcome Survey	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-Longitudinal Web Consent and Assent	Attachment 05c_Parental Permission_Youth Assent_Longitudinal Age 12-17_Web_FU5.docx	Yes	Yes	Printable Only
Other-Longitudinal Web Consent 18+ Year Old Youth	Attachment 05d_Informed Consent_Longitudinal Age 18_Web_FU5.docx	Yes	Yes	Printable Only
Other-Youth Assent Longitudinal Age 15 - 17 Social Media Permission Waived Web	Attachment 05i_Youth Assent_ Age 15 - 17_Social Media_Permission Waived_Web_FU5.docx	Yes	Yes	Fillable Fileable
Other-Outcome Web Screener	Attachment 03_EFECT_Outcome_Web_Screener_FU5.docx	Yes	Yes	Fillable Fileable
Other-Cross Sectional Social Media_Snowball 15+ Youth	Attachment 05e_Youth Assent_Cross Sectional Age 15 - 17_Social Media_Web_FU5.docx	Yes	Yes	Fillable Fileable
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 Fileable
Other-Youth Assent Longitudinal Age 13 - 17 Social Media Web	Attachment 05g_Youth Assent_Longitudinal Age 13 - 17_Social Media_Web_FU5.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: 40,000	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	40,000	40,000
Annual IC Time Burden (Hours)	3,332	3,332
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.