Adult Parental Permission Process – Outcome Survey

Evaluation of the Food and Drug Administration's 'Fresh Empire' Multicultural Youth Tobacco Prevention Campaign.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0788 can be found here:

Documents and Forms

Document Name Document Type
Attachment 05_Parental Permission_Youth Assent_Cross Sectional_Age 12 - 17_Household_FU4.docx Other-Informed Consent and Assent
Attachment 08_Outcome Parent Lead Letter_Cross-Sectional_FU4.docx Other-Outcome Parent Lead Letter (Cr
Attachment 05a_Parental Permission_Youth Assent_Longitudinal Age 12- 17_Household_FU4.docx Other-Longitudinal Informed Consent
Attachment 08a_Outcome Parent Lead Letter_Longitudinal_FU4.docx Other-Outcome Parent Lead Letter (Lo
Attachment 05c_Parental Permission_Youth Assent_Longitudinal Age 12-17_Web_FU4.docx Other-Longitudinal Informed Consent

Information Collection (IC) Details

IC Title:	Adult Parental Permission Process – 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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Informed Consent and Assent	Attachment 05_Parental Permission_Youth Assent_Cross Sectional_Age 12 - 17_Household_FU4.docx	No		Printable Only
Other-Outcome Parent Lead Letter (Cross-Sectional)	Attachment 08_Outcome Parent Lead Letter_Cross-Sectional_FU4.docx	No		Paper Only
Other-Longitudinal Informed Consent and Assent (Household)	Attachment 05a_Parental Permission_Youth Assent_Longitudinal Age 12- 17_Household_FU4.docx	No		Printable Only
Other-Outcome Parent Lead Letter (Longitudinal)	Attachment 08a_Outcome Parent Lead Letter_Longitudinal_FU4.docx	No		Paper Only
Other-Longitudinal Informed Consent and Assent (Web)	Attachment 05c_Parental Permission_Youth Assent_Longitudinal Age 12-17_Web_FU4.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,905	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	30,905	10,569	20,336
Annual IC Time Burden (Hours)	513	175	338
Annual IC Cost Burden (Dollars)	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.