Information Collection

Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging

IC 235670 under ICR 201907-0910-006 · OMB 0910-0810.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0810 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A5 Fresh Empire survey.docx	Other-Attachment A5 - Fresh Empire S
Attachment A6 Cigarette, Cigar, Hookah, and E-cigarette Facts.docx	Other-Attachment A6 - Cigarette, Cig
Attachment B5 TRC Smokeless survey.docx	Other-Attachment B5 - Smokeless Surv
Attachment B6 Smokeless Tobacco Facts.docx	Other-Attachment B6 - Smokeless Toba
Attachment C1 Fresh Empire youth assent - survey.docx	Other-Attachment C1 - Fresh Empire Y
Attachment C2 Fresh Empire parental notification opt out - survey.docx	Other-Attachment C2 - Fresh Empire P
Attachment C3 Fresh Empire screener - survey.docx	Other-Attachment C3 Fresh Empire Scr
Attachment C4 Fresh Empire Recruitment Ads.docx	Other-Attachment C4 Fresh Empire Rec
Attachment D1 TRC Smokeless youth assent - survey.docx	Other-Attachment D1 TRC Smokeless Yo
Attachment D2 TRC Smokeless parental notification opt out - survey.docx	Other-Attachment D2 TRC Smokeless Pa
Attachment D3 TRC Smokeless screener - survey.docx	Other-Attachment D3 TRC Smokeless Sc
Attachment D4 TRC Smokeless Recruitment Ads.docx	Other-Attachment D4 TRC Smokeless Re
Attachment E1 AI-AN youth assent (Social media).docx	Other-Attachment E1 AI-AN Youth Asse
Attachment E2 AI-AN parental notification opt out (Social media).docx	Other-Attachment E2 AI-AN Parental N
Attachment E3 AI-AN screener (Social media).docx	Other-Attachment E3 AI-AN Screener (
Attachment E4 AI-AN Recruitment Ads (Social media).docx	Other-Attachment E4 AI-AN Recruitmen
Attachment E5 AI-AN survey.docx	Other-Attachment E5 AI-AN Survey
Attachment E6 AI-AN Cigarette and E-cigarette Facts.docx	Other-Attachment E6 AI-AN Cigarette
Attachment F1 AI-AN Invitation and Parental Permission (Online Panel).docx	Other-Attachment F1 AI-AN Invitation
Attachment F2 - AI-AN Youth Assent (Online Panel).docx	Other-Attachment F2 - AI-AN Youth As
Attachment F3 - AI-AN Screener (Online Panel).docx	Other-Attachment F3 - AI-AN Screener
0810_OMB Gen IC Memo Part A Supporting Statement.docx OMB approval memo	IC Document
0810_OMB Gen IC Memo Part B Supporting Statement.docx OMB approval memo Part B	IC Document
18-049CTP Chair Letter Approved 10-04-18.pdf Approval Letter	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging

Agency IC Tracking Number:

CTP

IC Status: Unchanged

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-Attachment A5 - Fresh Empire Survey	Attachment A5 Fresh Empire survey.docx	Yes	Yes	Fillable Fileable
Other-Attachment A6 - Cigarette, Cigar, Hookah, and E-Cig Facts	Attachment A6 Cigarette, Cigar, Hookah, and E-cigarette Facts.docx	Yes	No	Paper Only
Other-Attachment B5 - Smokeless Survey	Attachment B5 TRC Smokeless survey.docx	Yes	Yes	Fillable Fileable
Other-Attachment B6 - Smokeless Tobacco Facts	Attachment B6 Smokeless Tobacco Facts.docx	Yes	No	Paper Only
Other-Attachment C1 - Fresh Empire Youth Assent Survey	Attachment C1 Fresh Empire youth assent - survey.docx	Yes	Yes	Fillable Fileable
Other-Attachment C2 - Fresh Empire Parental Notification Opt Out Survey	Attachment C2 Fresh Empire parental notification opt out - survey.docx	Yes	Yes	Fillable Fileable
Other-Attachment C3 Fresh Empire Screener - Survey	Attachment C3 Fresh Empire screener - survey.docx	Yes	No	Paper Only
Other-Attachment C4 Fresh Empire Recruitment Ads	Attachment C4 Fresh Empire Recruitment Ads.docx	Yes	No	Paper Only
Other-Attachment D1 TRC Smokeless Youth Assent - Survey	Attachment D1 TRC Smokeless youth assent - survey.docx	Yes	No	Fillable Fileable
Other-Attachment D2 TRC Smokeless Parental Notification Opt Out - Survey	Attachment D2 TRC Smokeless parental notification opt out - survey.docx	Yes	No	Paper Only
Other-Attachment D3 TRC Smokeless Screener - Survey	Attachment D3 TRC Smokeless screener - survey.docx	Yes	No	Paper Only
Other-Attachment D4 TRC Smokeless Recruitment Ads	Attachment D4 TRC Smokeless Recruitment Ads.docx	Yes	No	Paper Only
Other-Attachment E1 AI-AN Youth Assent (Social Media)	Attachment E1 AI-AN youth assent (Social media).docx	Yes	No	Paper Only
Other-Attachment E2 AI-AN Parental Notification Opt Out (Social Media)	Attachment E2 AI-AN parental notification opt out (Social media).docx	Yes	No	Paper Only
Other-Attachment E3 AI-AN Screener (Social Media)	Attachment E3 AI-AN screener (Social media).docx	Yes	No	Paper Only
Other-Attachment E4 AI-AN Recruitment Ads (Social Media)	Attachment E4 AI-AN Recruitment Ads (Social media).docx	Yes	No	Paper Only
Other-Attachment E5 AI-AN Survey	Attachment E5 AI-AN survey.docx	Yes	Yes	Fillable Fileable
Other-Attachment E6 AI-AN Cigarette and E-Cigarette Facts	Attachment E6 AI-AN Cigarette and E-cigarette Facts.docx	Yes	No	Paper Only
Other-Attachment F1 AI-AN Invitation and Parental Permission (Online Panel)	Attachment F1 AI-AN Invitation and Parental Permission (Online Panel).docx	Yes	No	Paper Only
Other-Attachment F2 - AI-AN Youth Assent (Online Panel)	Attachment F2 - AI-AN Youth Assent (Online Panel).docx	Yes	No	Paper Only
Other-Attachment F3 - AI-AN Screener (Online Panel)	Attachment F3 - AI-AN Screener (Online Panel).docx	Yes	No	Paper 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: 5,860

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	5,860	5,860
Annual IC Time Burden (Hours)	1,371	1,371
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB approval memo	0810_OMB Gen IC Memo Part A Supporting Statement.docx	04/12/2019
OMB approval memo Part B	0810_OMB Gen IC Memo Part B Supporting Statement.docx	04/12/2019
Approval Letter	18-049CTP Chair Letter Approved 10-04-18.pdf	04/12/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.