Information Collection

Hispanic/Latino Youth and Young Adult Tobacco Use Online Survey Study

IC 257913 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⚠️ Notice: This information collection may be referencing outdated material.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
Hispanic Audience - Sample Recruitment Email.docx	Other-Sample Recruitment Email
Hispanic Audience - Sample Recruitment Email.docx	Other-Sample Recruitment Email
Hispanic Audience Survey Screener.docx	Other-Survey Screener
Hispanic Audience Survey Screener.docx	Other-Survey Screener
Participant Consent_Assent Form.docx	Other-Consent and Assent Form
Participant Consent_Assent Form.docx	Other-Consent and Assent Form
Hispanic Audience Parental Opt Out Form.docx	Other-Parental Opt Out Form
Hispanic Audience Parental Opt Out Form.docx	Other-Parental Opt Out Form
Hispanic Audience Main Survey.docx	Other-Survey
Hispanic Audience Main Survey.docx	Other-Survey
0810 SS_Part A_Hispanic Audience Online Survey.docx Generic Memo (SSA)	IC Document
0810 SS_Part A_Hispanic Audience Online Survey.docx Generic Memo (SSA)	IC Document
0810 SS_Part B_Hispanic Audience Online Survey.docx Generic Memo (SSB)	IC Document
0810 SS_Part B_Hispanic Audience Online Survey.docx Generic Memo (SSB)	IC Document
Hispanic Audience IRB Approval.pdf IRB Approval	IC Document
Hispanic Audience IRB Approval.pdf IRB Approval	IC Document

IC Title:

Hispanic/Latino Youth and Young Adult Tobacco Use Online Survey 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-Sample Recruitment Email	Hispanic Audience - Sample Recruitment Email.docx	Yes	Yes	Fillable Fileable
Other-Survey Screener	Hispanic Audience Survey Screener.docx	Yes	Yes	Fillable Fileable
Other-Consent and Assent Form	Participant Consent_Assent Form.docx	Yes	Yes	Fillable Fileable
Other-Parental Opt Out Form	Hispanic Audience Parental Opt Out Form.docx	Yes	Yes	Fillable Fileable
Other-Survey	Hispanic Audience Main Survey.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,750

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	1,339	1,339
Annual IC Time Burden (Hours)	1,339	1,339
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Memo (SSA)	0810 SS_Part A_Hispanic Audience Online Survey.docx	02/13/2023
Generic Memo (SSB)	0810 SS_Part B_Hispanic Audience Online Survey.docx	02/13/2023
IRB Approval	Hispanic Audience IRB Approval.pdf	02/13/2023

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