Information Collection

Youth Assent and Online Survey

IC 257907 under ICR 202301-0910-009 · OMB 0910-0914.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 1. Monthly Monitoring Study_ENDS Survey.docx	Other-Monthly Monitoring Study ENDS
Attachment 1. Monthly Monitoring Study_ENDS Survey.docx	Other-Monthly Monitoring Study ENDS
Attachment 2. Monthly Monitoring Study Youth Assent_ENDS.docx	Other-Youth Assent
Attachment 2. Monthly Monitoring Study Youth Assent_ENDS.docx	Other-Youth Assent

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Monthly Monitoring Study ENDS Screener/Survey			Attachment 1. Monthly Monitoring Study_ENDS Survey.docx		Yes	Yes	Fillable Fileable Signable
Other-Youth Assent			Attachment 2. Monthly Monitoring Study Youth Assent_ENDS.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 27,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	27,000	27,000
Annual IC Time Burden (Hours)	10,125	10,125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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