Information Collection

Gathering Consumer Feedback on The Real Cost Campaign (ENDS Ad Focus)

IC 265585 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⚠️ Notice: This information collection may be referencing outdated material.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 B - Parental Opt-Out.docx	Other-Parental Opt-Out
Appendix C- Brief Assent and Screener.docx	Other-Brief Assent and Screener
Appendix D - Youth Full Assent Form.docx	Other-Youth Full Assent Form
Appendix E- ENDS IMT Survey.docx	Other-Survey
Scripts.docx	Other-Scripts
0810 OMB memo ENDS Ad.docx OMB Justification Memo	IC Document
IRB Letter.pdf IRB Letter	IC Document

IC Title:

Gathering Consumer Feedback on The Real Cost Campaign (ENDS Ad Focus)

Agency IC Tracking Number:

CTP

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Email Invitation for Parents of Youth	Yes	Yes	Fillable Fileable Signable
Other-Parental Opt-Out	Yes	Yes	Fillable Fileable Signable
Other-Brief Assent and Screener	Yes	Yes	Fillable Fileable Signable
Other-Youth Full Assent Form	Yes	Yes	Fillable Fileable Signable
Other-Survey	Yes	Yes	Fillable Fileable
Other-Scripts	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,750

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,750	3,750
Annual IC Time Burden (Hours)	925	925
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Justification Memo		02/23/2024
IRB Letter		02/23/2024

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

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