Information Collection

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

IC 268538 under ICR 202507-0920-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
[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 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
Activity Guide Attachment 4 - Activity Guide.docx Form and Instruction
Attachment 5-Progammed Activities.pdf Programmed Activities IC Document
Attachment 6 - Materials for Testing.docx Materials for Testing 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 8 - IRB Determination Letter.pdf Research Determination 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 B-Youth Message Testing.docx SSB 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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Parent and Child Screeners	Attachment 1 - Screener_OIRA Feedback-YPulse-FM 07.29.2024 - clean 7.30.24.docx	Yes	No	Fillable Fileable
Other-Consent			Attachment 2 - Parent Legal Guardian Consent Form - 07.30.2024.docx	Yes	Yes	Fillable Fileable
Other-Consent			Attachment 3 - Youth Assent Form - 07.30.2024.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Activity Guide	Attachment 4 - Activity Guide.docx	Yes	Yes	Fillable Fileable

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 %

	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

Title	Document	Date Uploaded
Programmed Activities	Attachment 5-Progammed Activities.pdf	06/13/2024
Materials for Testing	Attachment 6 - Materials for Testing.docx	06/13/2024
Privacy Agreement	Attachment 7 - Privacy Agreement.docx	06/13/2024
PTA	Attachment 7a-Youth Message Testing-PTA_01-08-2024 - Signed.pdf	06/13/2024
Research Determination	Attachment 8 - IRB Determination Letter.pdf	06/13/2024
Recruitment and Follow Up Materials	Attachment 9 - Recruitment & Follow Up Materials.docx	06/13/2024
SSA	Supporting Statement A-Youth Message Testing 5.7 JK1-FM-5.13_final.docx	06/13/2024
SSB	Supporting Statement B-Youth Message Testing.docx	06/13/2024
GenIC Request Template	GenIC Request_Formative Research-Youth Message Testing_final.docx	06/13/2024

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].