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Federal forms, ICRs, and supporting documents

Information Collection

FDA Tobacco Prevention Broad Quantitative Research Package (CTP)

IC 239960 under ICR 202101-0910-013 · OMB 0910-0810.

Documents and Forms
Document Name
Document Type
Other-Parental Notification and Opt-
Other-Parental Notification and Opt-
Other-Email Invitation
Other-Email Invitation
Other-Youth Assent Form
Other-Youth Assent Form
Other-Adult Consent Form
Other-Adult Consent Form
Other-Youth Screener
Other-Youth Screener
Other-Adult Screener
Other-Adult Screener
Other-Survey Instrument
Other-Survey Instrument
Other-Adult Survey Instrument
Other-Adult Survey Instrument
Other-Stimuli
Other-Stimuli
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

FDA Tobacco Prevention Broad Quantitative Research Package (CTP) CTP
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL 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

Health Consumer Health and Safety

 

22,000 0
   
Individuals or Households
 
   0 %

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

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.