The Real Cost Smokeless: Wave 2 Focus Group Study of Reactions to Creative Advertising Concepts Designed to Prevent Rural Youth Tobacco Use

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0796 can be found here:

Documents and Forms

Document Name Document Type
Attachment A - Screener.docx Other-Screener
Attachment B1- Parent-Guardian Permission Form.docx Other-Parent-Guardian Permission For
Attachment B2- Parent-Guardian Opt-out Form.docx Other-Parent-Guardian Opt-out Form
Attachment C - Youth Assent Form.docx Other-Youth Assent Form
Attachment D - Discussion Guide.docx Other-Discussion Guide
Attachment E- Study Stimuli.docx Other-Study Stimuli
Attachment F - Concept Rating Worksheet.docx Other-Concept Rating Worksheet
Attachment G - Concept Ranking Worksheet.docx Other-Concept Ranking Worksheet
Smokeless W2 OMB Memo.docx Generic Memo IC Document
Attachment H - IRB Letter.pdf IRB Letter IC Document

Information Collection (IC) Details

IC Title:	The Real Cost Smokeless: Wave 2 Focus Group Study of Reactions to Creative Advertising Concepts Designed to Prevent Rural Youth Tobacco Use	Agency IC Tracking Number:	CTP

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener	Attachment A - Screener.docx	Yes	Yes	Fillable Printable
Other-Parent-Guardian Permission Form	Attachment B1- Parent-Guardian Permission Form.docx	No		Paper Only
Other-Parent-Guardian Opt-out Form	Attachment B2- Parent-Guardian Opt-out Form.docx	No		Paper Only
Other-Youth Assent Form	Attachment C - Youth Assent Form.docx	No		Paper Only
Other-Discussion Guide	Attachment D - Discussion Guide.docx	No		Paper Only
Other-Study Stimuli	Attachment E- Study Stimuli.docx	No		Printable Only
Other-Concept Rating Worksheet	Attachment F - Concept Rating Worksheet.docx	No		Paper Only
Other-Concept Ranking Worksheet	Attachment G - Concept Ranking Worksheet.docx	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 576	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	576	576
Annual IC Time Burden (Hours)	276	276
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Memo	Smokeless W2 OMB Memo.docx	12/11/2017
IRB Letter	Attachment H - IRB Letter.pdf	12/11/2017

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