Information Collection

FDA Tobacco Prevention Broad Quantitative Research Package (CTP)

IC 239960 under ICR 202101-0910-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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 A_Parental Notification and Opt-Out.docx	Other-Parental Notification and Opt-
Attachment A_Parental Notification and Opt-Out.docx	Other-Parental Notification and Opt-
Attachment A1_Email Invite.docx	Other-Email Invitation
Attachment A1_Email Invite.docx	Other-Email Invitation
Attachment B_ Youth Assent Form.docx	Other-Youth Assent Form
Attachment B_ Youth Assent Form.docx	Other-Youth Assent Form
Attachment C - Adult Participant Consent Form.docx	Other-Adult Consent Form
Attachment C - Adult Participant Consent Form.docx	Other-Adult Consent Form
Attachment D_ Youth Screener.docx	Other-Youth Screener
Attachment D_ Youth Screener.docx	Other-Youth Screener
Attachment E_ Adult Screener.docx	Other-Adult Screener
Attachment E_ Adult Screener.docx	Other-Adult Screener
Attachment F_Youth Questionnaire.docx	Other-Survey Instrument
Attachment F_Youth Questionnaire.docx	Other-Survey Instrument
Attachment G_Adult Questionnaire.docx	Other-Adult Survey Instrument
Attachment G_Adult Questionnaire.docx	Other-Adult Survey Instrument
STIMULI_03232020.docx	Other-Stimuli
STIMULI_03232020.docx	Other-Stimuli
0810 Supporting Statement Part A Tobacco Prevention Broad Quantitative Research 2020.docx 0810 Supporting Statement Part A	IC Document
0810 Supporting Statement Part A Tobacco Prevention Broad Quantitative Research 2020.docx 0810 Supporting Statement Part A	IC Document
0810 Supporting Statement Part B Tobacco Prevention Broad QR 2020.docx 0810 Supporting Statement Part B	IC Document
0810 Supporting Statement Part B Tobacco Prevention Broad QR 2020.docx 0810 Supporting Statement Part B	IC Document
Attachment I_ IRB Letter.pdf IRB Approval Letter	IC Document
Attachment I_ IRB Letter.pdf IRB Approval Letter	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

FDA Tobacco Prevention Broad Quantitative Research Package (CTP)

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-Parental Notification and Opt-Out	Attachment A_Parental Notification and Opt-Out.docx	Yes	No	Printable Only
Other-Email Invitation	Attachment A1_Email Invite.docx	Yes	No	Printable Only
Other-Youth Assent Form	Attachment B_ Youth Assent Form.docx	Yes	Yes	Fillable Fileable
Other-Adult Consent Form	Attachment C - Adult Participant Consent Form.docx	Yes	Yes	Fillable Fileable
Other-Youth Screener	Attachment D_ Youth Screener.docx	Yes	Yes	Fillable Fileable
Other-Adult Screener	Attachment E_ Adult Screener.docx	Yes	Yes	Fillable Fileable
Other-Survey Instrument	Attachment F_Youth Questionnaire.docx	Yes	Yes	Fillable Fileable
Other-Adult Survey Instrument	Attachment G_Adult Questionnaire.docx	Yes	Yes	Fillable Fileable
Other-Stimuli	STIMULI_03232020.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: 22,000

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	22,000	22,000
Annual IC Time Burden (Hours)	5,596	5,596
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0810 Supporting Statement Part A	0810 Supporting Statement Part A Tobacco Prevention Broad Quantitative Research 2020.docx	02/13/2020
0810 Supporting Statement Part B	0810 Supporting Statement Part B Tobacco Prevention Broad QR 2020.docx	02/13/2020
IRB Approval Letter	Attachment I_ IRB Letter.pdf	02/13/2020

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