Information Collection

The Real Cost Campaign: Media Tracking Study

IC 252375 under ICR 202308-0910-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Invitation for Parents o
Appendix A - Email Invitation for Parents of Youth.docx	Other-Email Invitation for Parents o
Appendix B - Parental Notification and Opt-Out Form.docx	Other-Parental Notification and Opt-
Appendix B - Parental Notification and Opt-Out Form.docx	Other-Parental Notification and Opt-
Appendix C - Youth Assent Form.docx	Other-Youth Assent Form
Appendix C - Youth Assent Form.docx	Other-Youth Assent Form
Appendix D- Screener.docx	Other-Screener
Appendix D- Screener.docx	Other-Screener
Appendix E- Survey.docx	Other-Survey
Appendix E- Survey.docx	Other-Survey
Media Tracking Study Part A Supporting Statement_2022 03_2.0.docx 0810 Gen IC SS A	IC Document
Media Tracking Study Part A Supporting Statement_2022 03_2.0.docx 0810 Gen IC SS A	IC Document
Media Tracking Study Part B Supporting Statement_2022 03.docx 0810 Gen IC SS B	IC Document
Media Tracking Study Part B Supporting Statement_2022 03.docx 0810 Gen IC SS B	IC Document
IRB approval 2022.pdf IRB Letter	IC Document
IRB approval 2022.pdf IRB Letter	IC Document

IC Title:

The Real Cost Campaign: Media Tracking Study

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-Email Invitation for Parents of Youth	Appendix A - Email Invitation for Parents of Youth.docx	Yes	Yes	Printable Only
Other-Parental Notification and Opt-Out Form	Appendix B - Parental Notification and Opt-Out Form.docx	Yes	Yes	Printable Only
Other-Youth Assent Form	Appendix C - Youth Assent Form.docx	Yes	Yes	Printable Only
Other-Screener	Appendix D- Screener.docx	Yes	No	Printable Only
Other-Survey	Appendix E- Survey.docx	Yes	Yes	Fillable Printable

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)	1,051	1,051
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0810 Gen IC SS A	Media Tracking Study Part A Supporting Statement_2022 03_2.0.docx	07/08/2022
0810 Gen IC SS B	Media Tracking Study Part B Supporting Statement_2022 03.docx	03/25/2022
IRB Letter	IRB approval 2022.pdf	03/25/2022

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