The Real Cost Smokeless: Wave 2 In-depth Interviews 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⚠️ Notice: This information collection may be referencing outdated material.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 B - Parent Guardian Permission.docx Other-Parent Guardian Permission For
Attachment C - Parent Guardian Opt-out.docx Other-Parent Guardian Opt-out Form
Attachment D - Youth Assent Form.docx Other-Youth Assent Form
Attachment E - Discussion Guide.docx Other-Discussion Guide
Attachment F - Map Example Center of Town.pdf Other-Google Map Example Center of T
Attachment H - Tobacco Product Image Boards.pdf Other-Tobacco Product Image Boards
Attachment I - Interview Activity.docx Other-Interview Activity
Attachment G - Map Example Entire Town.pdf Other-Google Map Example Entire Town
SMKLS W2 IDI OMB Memo.docx OMB Memo IC Document
Attachment J - IRB Letter.pdf IRB Letter IC Document

Information Collection (IC) Details

IC Title:	The Real Cost Smokeless: Wave 2 In-depth Interviews 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 B - Parent Guardian Permission.docx	No		Paper Only
Other-Parent Guardian Opt-out Form	Attachment C - Parent Guardian Opt-out.docx	No		Paper Only
Other-Youth Assent Form	Attachment D - Youth Assent Form.docx	No		Paper Only
Other-Discussion Guide	Attachment E - Discussion Guide.docx	No		Paper Only
Other-Google Map Example Center of Town	Attachment F - Map Example Center of Town.pdf	No		Printable Only
Other-Tobacco Product Image Boards	Attachment H - Tobacco Product Image Boards.pdf	No		Paper Only
Other-Interview Activity	Attachment I - Interview Activity.docx	No		Paper Only
Other-Google Map Example Entire Town	Attachment G - Map Example Entire Town.pdf	No		Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 88	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	88	88
Annual IC Time Burden (Hours)	54	54
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	SMKLS W2 IDI OMB Memo.docx	12/12/2017
IRB Letter	Attachment J - IRB Letter.pdf	12/12/2017

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