Information Collection

The Real Cost Campaign: Media Tracking Study (CTP)

IC 246465 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⚠️ Notice: This information collection may be referencing outdated material.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
Appendix A - Email Invitation for Parents of Youth.docx	Other-Email Invitations for Parents
Appendix B - Youth Assent Form.docx	Other-Youth Assent Form
Appendix C - Young Adult Consent Form.docx	Other-Young Adult Consent Form
Appendix D - Screener _REVISED 3-30.21.docx	Other-Screener
Appendix E - Questionnaire.docx	Other-Questionnaire
0810 GenIC Supporting Statement Part A - Media Tracking Study 2021.docx Supporting Statement Part A - Media Tracking Study	IC Document
0810 GenIC Supporting Statement Part B - Media Tracking Study 2021.docx Supporting Statement Part B - Media Tracking Study	IC Document
IRB Letter.pdf IRB Letter	IC Document

IC Title:

The Real Cost Campaign: Media Tracking Study (CTP)

Agency IC Tracking Number:

CTP

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Email Invitations for Parents	Yes	No	Printable Only
Other-Youth Assent Form	Yes	Yes	Fillable Fileable
Other-Young Adult Consent Form	Yes	Yes	Fillable Fileable
Other-Screener	Yes	Yes	Fillable Fileable
Other-Questionnaire	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,250	20,250
Annual IC Time Burden (Hours)	2,488	2,488
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Part A - Media Tracking Study		03/26/2021
Supporting Statement Part B - Media Tracking Study		03/26/2021
IRB Letter		03/26/2021

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

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