OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

IC 235670 under ICR 202101-0910-013 · OMB 0910-0810.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Attachment A5 Fresh Empire survey.docx Other-Attachment A5 - Fresh Empire S
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 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 B5 TRC Smokeless survey.docx Other-Attachment B5 - Smokeless Surv
Attachment B6 Smokeless Tobacco Facts.docx Other-Attachment B6 - Smokeless Toba
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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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
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 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
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
18-049CTP Chair Letter Approved 10-04-18.pdf
Approval Letter		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Attachment A5 - Fresh Empire Survey Yes Yes Fillable Fileable
Other-Attachment A6 - Cigarette, Cigar, Hookah, and E-Cig Facts Yes No Paper Only
Other-Attachment B5 - Smokeless Survey Yes Yes Fillable Fileable
Other-Attachment B6 - Smokeless Tobacco Facts Yes No Paper Only
Other-Attachment C1 - Fresh Empire Youth Assent Survey Yes Yes Fillable Fileable
Other-Attachment C2 - Fresh Empire Parental Notification Opt Out Survey Yes Yes Fillable Fileable
Other-Attachment C3 Fresh Empire Screener - Survey Yes No Paper Only
Other-Attachment C4 Fresh Empire Recruitment Ads Yes No Paper Only
Other-Attachment D1 TRC Smokeless Youth Assent - Survey Yes No Fillable Fileable
Other-Attachment D2 TRC Smokeless Parental Notification Opt Out - Survey Yes No Paper Only
Other-Attachment D3 TRC Smokeless Screener - Survey Yes No Paper Only
Other-Attachment D4 TRC Smokeless Recruitment Ads Yes No Paper Only
Other-Attachment E1 AI-AN Youth Assent (Social Media) Yes No Paper Only
Other-Attachment E2 AI-AN Parental Notification Opt Out (Social Media) Yes No Paper Only
Other-Attachment E3 AI-AN Screener (Social Media) Yes No Paper Only
Other-Attachment E4 AI-AN Recruitment Ads (Social Media) Yes No Paper Only
Other-Attachment E5 AI-AN Survey Yes Yes Fillable Fileable
Other-Attachment E6 AI-AN Cigarette and E-Cigarette Facts Yes No Paper Only
Other-Attachment F1 AI-AN Invitation and Parental Permission (Online Panel) Yes No Paper Only
Other-Attachment F2 - AI-AN Youth Assent (Online Panel) Yes No Paper Only
Other-Attachment F3 - AI-AN Screener (Online Panel) Yes No Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,860 0 0 0 0 5,860
Annual IC Time Burden (Hours) 1,371 0 0 0 0 1,371
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
OMB approval memo 04/12/2019
OMB approval memo Part B 04/12/2019
Approval Letter 04/12/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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