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⚠️ Notice: This information collection may be referencing outdated material.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 3_E2a. Parent Guardian Tablet Screener ExPECTT.docx Other-Parent Guardian Tablet Screene
Attachment 3_E2b. Parent Guardian Mail Screener ExPECTT.docx Other-Parent Guardian Mail Screener
Attachment 3a_Parent Mail_Screener (male rural smokeless) 0910-0753.docx Other-Parent Mail_Screener (male rur
Attachment 6_E1b. Parent Permission ExPECTT.doc Other-Parent Permission ExPECTT
Attachment 6_E2b. Parent Permission ExPECTT.doc Other- Parent Permission ExPECTT (2)
Attachment 6_R. Parent Permission (male rural smokeless).doc Other-Parent Permission (male rural

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
Other-Parent Guardian Tablet Screener ExPECTT	Attachment 3_E2a. Parent Guardian Tablet Screener ExPECTT.docx	Yes	Yes	Fillable Fileable
Other-Parent Guardian Mail Screener ExPECTT	Attachment 3_E2b. Parent Guardian Mail Screener ExPECTT.docx	No		Paper Only
Other-Parent Mail_Screener (male rural smokeless)	Attachment 3a_Parent Mail_Screener (male rural smokeless) 0910-0753.docx	No		Paper Only
Other-Parent Permission ExPECTT	Attachment 6_E1b. Parent Permission ExPECTT.doc	No		Paper Only
Other- Parent Permission ExPECTT (2)	Attachment 6_E2b. Parent Permission ExPECTT.doc	No		Paper Only
Other-Parent Permission (male rural smokeless)	Attachment 6_R. Parent Permission (male rural smokeless).doc	No		Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,880	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	30,880	17,467	13,413
Annual IC Time Burden (Hours)	5,250	2,970	2,280
Annual IC Cost Burden (Dollars)	0	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.