Hispanic/Latino Youth and Young Adult Tobacco Use Online Survey Study

Generic Clearance for the Collection of Quantitative Data on Tobacco Products and Communications

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0810 can be found here:

Documents and Forms

Document Name Document Type
Hispanic Audience - Sample Recruitment Email.docx Other-Sample Recruitment Email
Hispanic Audience - Sample Recruitment Email.docx Other-Sample Recruitment Email
Hispanic Audience Survey Screener.docx Other-Survey Screener
Hispanic Audience Survey Screener.docx Other-Survey Screener
Participant Consent_Assent Form.docx Other-Consent and Assent Form
Participant Consent_Assent Form.docx Other-Consent and Assent Form
Hispanic Audience Parental Opt Out Form.docx Other-Parental Opt Out Form
Hispanic Audience Parental Opt Out Form.docx Other-Parental Opt Out Form
Hispanic Audience Main Survey.docx Other-Survey
Hispanic Audience Main Survey.docx Other-Survey
0810 SS_Part A_Hispanic Audience Online Survey.docx Generic Memo (SSA) IC Document
0810 SS_Part A_Hispanic Audience Online Survey.docx Generic Memo (SSA) IC Document
0810 SS_Part B_Hispanic Audience Online Survey.docx Generic Memo (SSB) IC Document
0810 SS_Part B_Hispanic Audience Online Survey.docx Generic Memo (SSB) IC Document
Hispanic Audience IRB Approval.pdf IRB Approval IC Document
Hispanic Audience IRB Approval.pdf IRB Approval IC Document

Information Collection (IC) Details

IC Title:	Hispanic/Latino Youth and Young Adult Tobacco Use Online Survey Study	Agency IC Tracking Number:	CTP

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Sample Recruitment Email	Hispanic Audience - Sample Recruitment Email.docx	Yes	Yes	Fillable Fileable
Other-Survey Screener	Hispanic Audience Survey Screener.docx	Yes	Yes	Fillable Fileable
Other-Consent and Assent Form	Participant Consent_Assent Form.docx	Yes	Yes	Fillable Fileable
Other-Parental Opt Out Form	Hispanic Audience Parental Opt Out Form.docx	Yes	Yes	Fillable Fileable
Other-Survey	Hispanic Audience Main Survey.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,750	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,339	1,339
Annual IC Time Burden (Hours)	1,339	1,339
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Memo (SSA)	0810 SS_Part A_Hispanic Audience Online Survey.docx	02/13/2023
Generic Memo (SSB)	0810 SS_Part B_Hispanic Audience Online Survey.docx	02/13/2023
IRB Approval	Hispanic Audience IRB Approval.pdf	02/13/2023

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