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Federal forms, ICRs, and supporting documents

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 202308-0910-006 · OMB 0910-0810.

Documents and Forms
Document Name
Document Type
Other-Youth assent form
Other-Youth assent form
Other-Parental notification and opt
Other-Parental notification and opt
Other-Screener
Other-Screener
Other-Survey
Other-Survey
Other-Email invitation
Other-Email invitation
Other-Stimuli
Other-Stimuli
Other-IRB approval
Other-IRB approval
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL 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

Health Consumer Health and Safety

 

750 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 750 0 0 0 0 750
Annual IC Time Burden (Hours) 160 0 0 0 0 160
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.