General Population Screener and Consent Process (Youth and Parent)

Evaluation of the Food and Drug Administration's General Market Youth Tobacco Prevention Campaign

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0753 can be found here:

Documents and Forms

Document Name Document Type
Attachment 5_Incentives_tracked changes.doc Instruction
Attachment 3_Parent or Guardian Screener and Instrument_tracked changes.doc Instruction
Attachment 6_Permission Assent Consent_tracked changes.doc Instruction
Attachment 7_Introduction to Study_tracked changes.doc Instruction
Attachment 8_Study Description_tracked changes.doc Instruction
Attachment 9_Privacy and Data Security.doc Instruction
Attachment 11_Questions and Answers about the ExPECTT Evaluation_tracked changes.doc Instruction
Attachment 10_Baseline Parent Lead Letter_tracked changes.doc Instruction
Attachment 12_Telephone Verification Survey_tracked changes.doc Other-Survey
Attachment 13_Notifications_tracked changes.doc Instruction

Information Collection (IC) Details

IC Title:	General Population Screener and Consent Process (Youth and Parent)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Attachment 5_Incentives_tracked changes.doc	Yes	No	Printable Only
Instruction	Attachment 3_Parent or Guardian Screener and Instrument_tracked changes.doc	Yes	No	Fillable Printable
Instruction	Attachment 6_Permission Assent Consent_tracked changes.doc	Yes	No	Printable Only
Instruction	Attachment 7_Introduction to Study_tracked changes.doc	Yes	No	Printable Only
Instruction	Attachment 8_Study Description_tracked changes.doc	Yes	No	Printable Only
Instruction	Attachment 9_Privacy and Data Security.doc	Yes	No	Printable Only
Instruction	Attachment 11_Questions and Answers about the ExPECTT Evaluation_tracked changes.doc	Yes	No	Printable Only
Instruction	Attachment 10_Baseline Parent Lead Letter_tracked changes.doc	Yes	No	Printable Only
Other-Survey	Attachment 12_Telephone Verification Survey_tracked changes.doc	Yes	No	Printable Only
Instruction	Attachment 13_Notifications_tracked changes.doc	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,413	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	13,413	13,413
Annual IC Time Burden (Hours)	2,280	2,280
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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