Information Collection

Creative Concept Testing Designed to Prevent Youth ENDS, Cigarette ad Other Tobacco Product

IC 238368 under ICR 202002-0910-001 · OMB 0910-0796.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0796 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A - Parental Permission Form.docx	Other-Parental Permission Form
Appendix B -Youth Assent Form.docx	Other-Youth Assent Form
Appendix C1 - Participant Screener.docx	Other-Participant Screener
Appendix C2 -Screener Contact Sheet.docx	Other-Screener Contact Sheet
Appendix D-Moderators Guide.doc	Other-Moderator's Guide
Appendix E - Concept Rating Sheet Clean.docx	Other-Concept Rating Sheet
Appendix F - Concept Ranking Sheet.docx	Other-Concept Ranking Sheet
Attachment G - Stimuli Global.docx	Other-Stimuli
OMB Approval Memo for Creative Concept Testing 2019.docx OMB Approval Memo	IC Document
FDA_IRB Letter 2019 1025 kdhrc.pdf IRB Letter	IC Document

IC Title:

Creative Concept Testing Designed to Prevent Youth ENDS, Cigarette ad Other Tobacco Product

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-Youth Assent Form	Appendix B -Youth Assent Form.docx	Yes	Yes	Fillable Printable
Other-Participant Screener	Appendix C1 - Participant Screener.docx	Yes	Yes	Fillable Printable
Other-Screener Contact Sheet	Appendix C2 -Screener Contact Sheet.docx	Yes	Yes	Fillable Printable
Other-Moderator's Guide	Appendix D-Moderators Guide.doc	No		Printable Only
Other-Concept Rating Sheet	Appendix E - Concept Rating Sheet Clean.docx	No		Paper Only
Other-Concept Ranking Sheet	Appendix F - Concept Ranking Sheet.docx	No		Paper Only
Other-Stimuli	Attachment G - Stimuli Global.docx	Yes	No	Printable Only
Other-Parental Permission Form	Appendix A - Parental Permission Form.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: 8,100

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	8,100	8,100
Annual IC Time Burden (Hours)	3,511	3,511
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Approval Memo	OMB Approval Memo for Creative Concept Testing 2019.docx	10/31/2019
IRB Letter	FDA_IRB Letter 2019 1025 kdhrc.pdf	10/31/2019

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