Information Collection

The Real Cost Campaign (W3): Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent Youth Tobacco Use

IC 255329 under ICR 202211-0910-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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
1. 0810 Rough Cut Youth Assent Form 8-16-2022.docx	Other-Youth assent form
1. 0810 Rough Cut Youth Assent Form 8-16-2022.docx	Other-Youth assent form
2. 0810 Rough Cut Parental Notification and Opt-Out 8-16-2022.docx	Other-Parental notification and opt
2. 0810 Rough Cut Parental Notification and Opt-Out 8-16-2022.docx	Other-Parental notification and opt
3. 0810 Rough Cut Screener 8-16-2022.docx	Other-Screener
3. 0810 Rough Cut Screener 8-16-2022.docx	Other-Screener
4. 0810 Rough Cut Survey 8-16-2022.docx	Other-Survey
4. 0810 Rough Cut Survey 8-16-2022.docx	Other-Survey
5. 0810 Rough Cut Email Invitation 8-16-2022.docx	Other-Email invitation
5. 0810 Rough Cut Email Invitation 8-16-2022.docx	Other-Email invitation
6. 0810 Rough Cut Stimuli 8-16-2022.docx	Other-Stimuli
6. 0810 Rough Cut Stimuli 8-16-2022.docx	Other-Stimuli
7. 0810 Rough Cut KDH IRB Approval 8-16-2022.pdf	Other-IRB approval
7. 0810 Rough Cut KDH IRB Approval 8-16-2022.pdf	Other-IRB approval
0810 Rough Cut Part A Supporting Statement 8-16-2022.docx SS part A - The Real Cost Campaign (W3): Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent You	IC Document
0810 Rough Cut Part A Supporting Statement 8-16-2022.docx SS part A - The Real Cost Campaign (W3): Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent You	IC Document
0810 Rough Cut Part B supportng statement 08-16-2022.docx SS part B - The Real Cost Campaign (W3): Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent You	IC Document
0810 Rough Cut Part B supportng statement 08-16-2022.docx SS part B - The Real Cost Campaign (W3): Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent You	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

The Real Cost Campaign (W3): Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent Youth Tobacco Use

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-Youth assent form	1. 0810 Rough Cut Youth Assent Form 8-16-2022.docx	Yes	Yes	Fillable Fileable
Other-Parental notification and opt out	2. 0810 Rough Cut Parental Notification and Opt-Out 8-16-2022.docx	Yes	Yes	Fillable Fileable
Other-Screener	3. 0810 Rough Cut Screener 8-16-2022.docx	Yes	Yes	Fillable Fileable
Other-Survey	4. 0810 Rough Cut Survey 8-16-2022.docx	Yes	Yes	Fillable Fileable
Other-Email invitation	5. 0810 Rough Cut Email Invitation 8-16-2022.docx	Yes	Yes	Fillable Fileable
Other-Stimuli	6. 0810 Rough Cut Stimuli 8-16-2022.docx	Yes	No	Printable Only
Other-IRB approval	7. 0810 Rough Cut KDH IRB Approval 8-16-2022.pdf	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: 750

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	160	160
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SS part A - The Real Cost Campaign (W3): Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent Youth Tobacco Use	0810 Rough Cut Part A Supporting Statement 8-16-2022.docx	08/16/2022
SS part B - The Real Cost Campaign (W3): Online Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent Youth Tobacco Use	0810 Rough Cut Part B supportng statement 08-16-2022.docx	08/16/2022

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