Information Collection

Youth 1st, 2nd, 3rd and 4th (Male, Rural Smokeless) follow up questionnaire

IC 208711 under ICR 201902-0910-009 · OMB 0910-0753.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0753 can be found here:

2022-04-07 - No material or nonsubstantive change to a currently approved collection
2020-09-23 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Attachment 02_R. Youth Follow up Instrument compressed (male rural smokeless) FU4.docx Other-Youth Followup3 Instrument (ma
Attachment 06_R2. Youth Assent (male rural smokeless) FU4.docx Other-Youth Assent (male rural smoke
Attachment 23_R. Incentive Letter (male rural smokeless).docx Other- Incentive Letter (male rural
Attachment 24_R. Consent Forms 18 (male rural smokeless) FU4.docx Other-Consent Forms 18 (male rural s
Attachment 25_R. Lead Letter 18 (male rural smokeless) FU4.docx Other-Lead Letter 18 (male rural smo
Attachment 26_R. Questions and Answers about the Evaluation 18 (male rural smokeless) FU4.docx Other-Questions and Answers about th
Attachment 27_R. Field Interviewer Verification - 18 (male rural smokeless) FU4.docx Other- Field Interviewer Verificatio
Attachment 28_R. Survey Invitation Email - 18 (male rural smokeless) FU4.docx Other-Survey Invitation Email - 18 (
Attachment 29_R. Email Reminder 1 - 18 (male rural smokeless) FU4.docx Other-Email Reminder 1 - 18 (male ru
Attachment 30_R. Email Reminder 2 -18 (male rural smokeless) FU4.docx Other-Email Reminder 2 -18 (male rur
Attachment 32_R. Panel Maintenance Letter - 18 (male rural smokeless) FU4.docx Other-Panel Maintenance Letter - 18
Attachment 33_R. Panel Maintenance Update Form - 18 (male rural smokeless) FU4.docx Other- Panel Maintenance Update Form
Attachment 34_R. No Response Reminder Letter - 18 (male rural smokeless) FU4.docx Other-No Response Reminder Letter -
Attachment 35_R. Panel Maintenance Email - 18 (male rural smokeless) FU4.docx Other-Panel Maintenance Email - 18 (
Attachment 2_R. Youth Followup 4 Instrument (male rural smokeless).docx Other-Youth Followup (1) 4 Instrumen
Attachment 31_R. Email Reminder 3 - 18 (male rural smokeless) FU4.docx Other-Email Reminder 3 - 18 (male ru
Attachment 36_R. Post_Card_Reminder_Notice FU4.docx Other-Post Card Reminder Notice

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Youth 1st, 2nd, 3rd and 4th (Male, Rural Smokeless) follow up questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Youth Followup3 Instrument (male rural smokeless)	Attachment 02_R. Youth Follow up Instrument compressed (male rural smokeless) FU4.docx	Yes	Yes	Fillable Fileable
Other-Youth Assent (male rural smokeless)	Attachment 06_R2. Youth Assent (male rural smokeless) FU4.docx	Yes	Yes	Fillable Fileable
Other- Incentive Letter (male rural smokeless)	Attachment 23_R. Incentive Letter (male rural smokeless).docx	No		Paper Only
Other-Consent Forms 18 (male rural smokeless)	Attachment 24_R. Consent Forms 18 (male rural smokeless) FU4.docx	Yes	Yes	Fillable Fileable
Other-Lead Letter 18 (male rural smokeless)	Attachment 25_R. Lead Letter 18 (male rural smokeless) FU4.docx	Yes	Yes	Fillable Fileable
Other-Questions and Answers about the Evaluation 18 (male rural smokeless)	Attachment 26_R. Questions and Answers about the Evaluation 18 (male rural smokeless) FU4.docx	Yes	Yes	Fillable Fileable
Other- Field Interviewer Verification - 18 (male rural smokeless)	Attachment 27_R. Field Interviewer Verification - 18 (male rural smokeless) FU4.docx	No		Fillable Printable
Other-Survey Invitation Email - 18 (male rural smokeless)	Attachment 28_R. Survey Invitation Email - 18 (male rural smokeless) FU4.docx	No		Printable Only
Other-Youth Followup (1) 4 Instrument (male rural smokeless	Attachment 2_R. Youth Followup 4 Instrument (male rural smokeless).docx	Yes	Yes	Fillable Fileable Signable
Other-Email Reminder 3 - 18 (male rural smokeless)	Attachment 31_R. Email Reminder 3 - 18 (male rural smokeless) FU4.docx	Yes	No	Printable Only
Other-Post Card Reminder Notice	Attachment 36_R. Post_Card_Reminder_Notice FU4.docx	No		Paper Only
Other-Email Reminder 1 - 18 (male rural smokeless)	Attachment 29_R. Email Reminder 1 - 18 (male rural smokeless) FU4.docx	No		Printable Only
Other-Email Reminder 2 -18 (male rural smokeless)	Attachment 30_R. Email Reminder 2 -18 (male rural smokeless) FU4.docx	No		Printable Only
Other-Panel Maintenance Letter - 18 (male rural smokeless)	Attachment 32_R. Panel Maintenance Letter - 18 (male rural smokeless) FU4.docx	No		Paper Only
Other- Panel Maintenance Update Form - 18 (male rural smokeless)	Attachment 33_R. Panel Maintenance Update Form - 18 (male rural smokeless) FU4.docx	No		Paper Only
Other-No Response Reminder Letter - 18 (male rural smokeless)	Attachment 34_R. No Response Reminder Letter - 18 (male rural smokeless) FU4.docx	No		Paper Only
Other-Panel Maintenance Email - 18 (male rural smokeless)	Attachment 35_R. Panel Maintenance Email - 18 (male rural smokeless) FU4.docx	Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,954	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,954	1,954
Annual IC Time Burden (Hours)	1,466	1,466
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.