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Adult Mail Screener and Consent Process for Outcome Survey
Evaluation of the Food and Drug Administration's 'Fresh Empire' Multicultural Youth Tobacco Prevention Campaign.
OMB: 0910-0788
IC ID: 215942
OMB.report
HHS/FDA
OMB 0910-0788
ICR 201708-0910-012
IC 215942
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0788 can be found here:
2019-02-12 - No material or nonsubstantive change to a currently approved collection
2018-08-02 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
Attachment 2_Outcome Mail Screener.docx
Other-Outcome Mail Screener
Attachment 5_Informed Consent and Assent.docx
Other-Informed Consent and Assent
Attachment 8a_Outcome Parent Lead Letter_Longitudinal_FU3.docx
Other-Outcome Parent Lead Letter
Attachment 5a_Parental Permission_Youth Assent_Longitudinal Age 12- 17_Household_FU3.docx
Other-Longitudinal Informed Consent
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Adult Mail Screener and Consent Process for Outcome Survey
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Outcome Mail Screener
Attachment 2_Outcome Mail Screener.docx
No
Printable Only
Other-Informed Consent and Assent
Attachment 5_Informed Consent and Assent.docx
No
Printable Only
Other-Outcome Parent Lead Letter
Attachment 8a_Outcome Parent Lead Letter_Longitudinal_FU3.docx
No
Paper Only
Other-Longitudinal Informed Consent and Assent
Attachment 5a_Parental Permission_Youth Assent_Longitudinal Age 12- 17_Household_FU3.docx
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
20,336
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
20,336
0
0
0
0
20,336
Annual IC Time Burden (Hours)
338
0
0
0
0
338
Annual IC Cost Burden (Dollars)
0
0
0
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.