Information Collection

[NCIPC] Youth Audience Message Testing of Substance Use Prevention Messages

IC 268538 under ICR 202503-0920-028 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
[NCIPC] Youth Audience Message Testing of Substance Use Prevention Messages	Form and Instruction
Parent and Child Screeners [NCIPC] Youth Audience Message Testing of Substance Use Prevention Messages	Form and Instruction
Activity Guide [NCIPC] Youth Audience Message Testing of Substance Use Prevention Messages	Form and Instruction
Attachment 2 - Parent Legal Guardian Consent Form - 07.30.2024.docx	Other-Consent
Attachment 2 - Parent Legal Guardian Consent Form - 07.30.2024.docx	Other-Consent
Attachment 3 - Youth Assent Form - 07.30.2024.docx	Other-Consent
Attachment 3 - Youth Assent Form - 07.30.2024.docx	Other-Consent
Parent and Child Screeners Attachment 1 - Screener_OIRA Feedback-YPulse-FM 07.29.2024 - clean 7.30.24.docx	Form and Instruction
Parent and Child Screeners Attachment 1 - Screener_OIRA Feedback-YPulse-FM 07.29.2024 - clean 7.30.24.docx	Form and Instruction
Activity Guide Attachment 4 - Activity Guide.docx	Form and Instruction
Activity Guide Attachment 4 - Activity Guide.docx	Form and Instruction
Attachment 5-Progammed Activities.pdf Programmed Activities	IC Document
Attachment 5-Progammed Activities.pdf Programmed Activities	IC Document
Attachment 6 - Materials for Testing.docx Materials for Testing	IC Document
Attachment 6 - Materials for Testing.docx Materials for Testing	IC Document
Attachment 7 - Privacy Agreement.docx Privacy Agreement	IC Document
Attachment 7 - Privacy Agreement.docx Privacy Agreement	IC Document
Attachment 7a-Youth Message Testing-PTA_01-08-2024 - Signed.pdf PTA	IC Document
Attachment 7a-Youth Message Testing-PTA_01-08-2024 - Signed.pdf PTA	IC Document
Attachment 8 - IRB Determination Letter.pdf Research Determination	IC Document
Attachment 8 - IRB Determination Letter.pdf Research Determination	IC Document
Attachment 9 - Recruitment & Follow Up Materials.docx Recruitment and Follow Up Materials	IC Document
Attachment 9 - Recruitment & Follow Up Materials.docx Recruitment and Follow Up Materials	IC Document
Supporting Statement A-Youth Message Testing 5.7 JK1-FM-5.13_final.docx SSA	IC Document
Supporting Statement A-Youth Message Testing 5.7 JK1-FM-5.13_final.docx SSA	IC Document
Supporting Statement B-Youth Message Testing.docx SSB	IC Document
Supporting Statement B-Youth Message Testing.docx SSB	IC Document
GenIC Request_Formative Research-Youth Message Testing_final.docx GenIC Request Template	IC Document
GenIC Request_Formative Research-Youth Message Testing_final.docx GenIC Request Template	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[NCIPC] Youth Audience Message Testing of Substance Use Prevention Messages

Agency IC Tracking Number:

0920-1154-24GK

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Yes	No	Fillable Fileable
Other-Consent		Yes	Yes	Fillable Fileable
Other-Consent		Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 638

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	638	638
Annual IC Time Burden (Hours)	256	256
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Programmed Activities		06/13/2024
Materials for Testing		06/13/2024
Privacy Agreement		06/13/2024
PTA		06/13/2024
Research Determination		06/13/2024
Recruitment and Follow Up Materials		06/13/2024
SSA		06/13/2024
SSB		06/13/2024
GenIC Request Template		06/13/2024

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

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