Information Collection

Nicotine Education Project: Qualitative Study to Gain Insights from Adult Current and Former Smokers to Educate the General Public about Changing Nicotine Standards

IC 237278 under ICR 202007-0910-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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_Consent Form.docx	Other-Consent Form
Appendix B_Screener_OMBEditClean 11.20.19.docx	Other-Screener
Appendix C_Screener Contact Sheet.docx	Other-Screener Contact Sheet
Appendix D_Moderator Guide Clean 11.12.19.docx	Other-Moderator Guide
Appendix E1 Check in Survey Current Smokers.docx	Other-Check in Survey Current Smoker
Appendix E2.docx	Other-Check in Survey Fomer Smokers
Appendix E3.docx	Other-Check in Survey Fomer Smokers
Appendix F_Check Out Form.docx	Other-Check Out Form
OMB Memo Clean 11 20 2019.docx OMB Justification Memo	IC Document
Nicotine Education Project_Advarra IRB.pdf IRB Approval	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Nicotine Education Project: Qualitative Study to Gain Insights from Adult Current and Former Smokers to Educate the General Public about Changing Nicotine Standards

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?	Electronic Capability
Other-Consent Form	Appendix A_Consent Form.docx	No	Fillable Printable
Other-Screener	Appendix B_Screener_OMBEditClean 11.20.19.docx	No	Paper Only
Other-Screener Contact Sheet	Appendix C_Screener Contact Sheet.docx	No	Printable Only
Other-Moderator Guide	Appendix D_Moderator Guide Clean 11.12.19.docx	No	Paper Only
Other-Check in Survey Current Smokers	Appendix E1 Check in Survey Current Smokers.docx	No	Paper Only
Other-Check in Survey Fomer Smokers Nicotine	Appendix E2.docx	No	Paper Only
Other-Check in Survey Fomer Smokers No Nicotine	Appendix E3.docx	No	Paper Only
Other-Check Out Form	Appendix F_Check Out Form.docx	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: 810

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	810	810
Annual IC Time Burden (Hours)	488	488
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Justification Memo	OMB Memo Clean 11 20 2019.docx	11/20/2019
IRB Approval	Nicotine Education Project_Advarra IRB.pdf	08/08/2019

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