Youth Baseline Questionnaire (Male Rural Smokeless)

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⚠️ Notice: This information collection may be referencing outdated material.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 2_Youth Baseline Instrument (male rural smokeless) 0910-0753.docx Other-Youth Baseline
Attachment 8_Study Description (male rural smokeless) 0910-0753.doc Other-Study Description
Attachment 19_R. Email_reminder1 (male rural smokeless).doc Other-Email Reminder 1 (male rural s
Attachment 20_R. Email_reminder2_(male rural smokeless).doc Other-Email Reminder 2 (male rural s
Attachment 21_R. Email_reminder3 (male rural smokeless).doc Other-Email Reminder 3 (male rural s
Attachment 6_R. Youth Assent (male rural smokeless)_REVISED.docx Other-Youth Assent (male rural smoke
Attachment 14_R. Notifications (male rural smokeless).doc Other-Notifications (male rural smok

Information Collection (IC) Details

IC Title:	Youth Baseline Questionnaire (Male Rural Smokeless)	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-Email Reminder 1 (male rural smokeless)	Attachment 19_R. Email_reminder1 (male rural smokeless).doc	Yes	No	Printable Only
Other-Email Reminder 2 (male rural smokeless)	Attachment 20_R. Email_reminder2_(male rural smokeless).doc	Yes	No	Printable Only
Other-Email Reminder 3 (male rural smokeless)	Attachment 21_R. Email_reminder3 (male rural smokeless).doc	Yes	No	Printable Only
Other-Notifications (male rural smokeless)	Attachment 14_R. Notifications (male rural smokeless).doc	No		Paper Only
Other-Youth Assent (male rural smokeless)	Attachment 6_R. Youth Assent (male rural smokeless)_REVISED.docx	Yes	Yes	Fillable Fileable
Other-Youth Baseline	Attachment 2_Youth Baseline Instrument (male rural smokeless) 0910-0753.docx	Yes	Yes	Fillable Fileable
Other-Study Description	Attachment 8_Study Description (male rural smokeless) 0910-0753.doc	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 656	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	656	656
Annual IC Time Burden (Hours)	328	328
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.