Information Collection

Monthly Monitoring Study: Little Cigar, Cigarillo, and Blunt Use Audience Insights Survey

IC 256409 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⚠️ Notice: This information collection may be referencing outdated material.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
LCC and Blunt Use Survey Questionnaire.docx	Other-LCC and Blunt Use Survey Quest
LCC and Blunt Use Survey Questionnaire.docx	Other-LCC and Blunt Use Survey Quest
LCC and Blunt Use Survey Screener.docx	Other-LCC and Blunt Use Survey Scree
LCC and Blunt Use Survey Screener.docx	Other-LCC and Blunt Use Survey Scree
LCC and Blunt Use Survey Young Adult Consent.docx	Other-LCC and Blunt Use Survey Young
LCC and Blunt Use Survey Young Adult Consent.docx	Other-LCC and Blunt Use Survey Young
LCC and Blunt Use Survey Youth Assent Form.docx	Other-LCC and Blunt Use Survey Youth
LCC and Blunt Use Survey Youth Assent Form.docx	Other-LCC and Blunt Use Survey Youth
OMB Part A Supporting Statement _LCC and Blunt Use Survey.docx OMB Part A Supporting Statement _LCC and Blunt Use Survey	IC Document
OMB Part A Supporting Statement _LCC and Blunt Use Survey.docx OMB Part A Supporting Statement _LCC and Blunt Use Survey	IC Document
OMB Part B Supporting Statement _LCC and Blunt Use Survey.docx OMB Part B Supporting Statement _LCC and Blunt Use Survey	IC Document
OMB Part B Supporting Statement _LCC and Blunt Use Survey.docx OMB Part B Supporting Statement _LCC and Blunt Use Survey	IC Document
IRB Duke Modification Approval Notice.pdf IRB Duke Modification Approval Notice	IC Document
IRB Duke Modification Approval Notice.pdf IRB Duke Modification Approval Notice	IC Document
IRB Facing Material Modification Approval Notice.pdf IRB Facing Material Modification Approval Notice	IC Document
IRB Facing Material Modification Approval Notice.pdf IRB Facing Material Modification Approval Notice	IC Document
0910-0810 - Monthly Monitoring Study LCC Blunt Use Privacy Protections.docx Monthly Monitoring Study LCC Blunt Use Privacy Protections	IC Document
0910-0810 - Monthly Monitoring Study LCC Blunt Use Privacy Protections.docx Monthly Monitoring Study LCC Blunt Use Privacy Protections	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Monthly Monitoring Study: Little Cigar, Cigarillo, and Blunt Use Audience Insights Survey

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-LCC and Blunt Use Survey Questionnaire	LCC and Blunt Use Survey Questionnaire.docx	Yes	Yes	Fillable Printable
Other-LCC and Blunt Use Survey Screener	LCC and Blunt Use Survey Screener.docx	Yes	Yes	Fillable Printable
Other-LCC and Blunt Use Survey Young Adult Consent	LCC and Blunt Use Survey Young Adult Consent.docx	Yes	Yes	Fillable Printable
Other-LCC and Blunt Use Survey Youth Assent Form	LCC and Blunt Use Survey Youth Assent Form.docx	Yes	Yes	Fillable Printable

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: 10,000

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	10,000	10,000
Annual IC Time Burden (Hours)	868	868
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Part A Supporting Statement _LCC and Blunt Use Survey	OMB Part A Supporting Statement _LCC and Blunt Use Survey.docx	10/13/2022
OMB Part B Supporting Statement _LCC and Blunt Use Survey	OMB Part B Supporting Statement _LCC and Blunt Use Survey.docx	10/13/2022
IRB Duke Modification Approval Notice	IRB Duke Modification Approval Notice.pdf	10/13/2022
IRB Facing Material Modification Approval Notice	IRB Facing Material Modification Approval Notice.pdf	10/13/2022
Monthly Monitoring Study LCC Blunt Use Privacy Protections	0910-0810 - Monthly Monitoring Study LCC Blunt Use Privacy Protections.docx	10/13/2022

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