Cross-Sectional Youth Refresher Sample, Post-test and Assent/Consent Process - Outcome Surveys 1-5

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⚠️ Notice: This information collection may be referencing outdated material.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 01_Post Campaign Instrument_FU4.docx Other-Post Campaign Instrument
Attachment 17_Verification Call Script_Age 13-17.docx Other-Verification Call Script
Attachment 05b_Informed Consent_Longitudinal Age 18_Household_FU4.docx Other-Informed Consent Longitudinal
Attachment 05_Parental Permission_Youth Assent_Cross Sectional_Age 12 - 17_Household_FU4.docx Other-Parental Permission Youth Asse
Attachment 05e_Youth Assent_Cross Sectional Age 15 - 17_Social Media_Web_FU4.docx Other-Youth Assent Cross Sectional A
Attachment 05f_Youth Assent_Cross Sectional Age 13 - 14_Social Media_Web_FU4.docx Other-Youth Assent Cross Sectional A

Information Collection (IC) Details

IC Title:	Cross-Sectional Youth Refresher Sample, Post-test and Assent/Consent Process - Outcome Surveys 1-5	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-Post Campaign Instrument	Attachment 01_Post Campaign Instrument_FU4.docx	Yes	Yes	Fillable Fileable
Other-Verification Call Script	Attachment 17_Verification Call Script_Age 13-17.docx	No		Printable Only
Other-Informed Consent Longitudinal Age 18 (Household)	Attachment 05b_Informed Consent_Longitudinal Age 18_Household_FU4.docx	No		Paper Only
Other-Parental Permission Youth Assent Cross Sectional Age 12 - 17 (Household)	Attachment 05_Parental Permission_Youth Assent_Cross Sectional_Age 12 - 17_Household_FU4.docx	No		Fillable Printable
Other-Youth Assent Cross Sectional Age 15 - 17 Social Media (Web)	Attachment 05e_Youth Assent_Cross Sectional Age 15 - 17_Social Media_Web_FU4.docx	Yes	Yes	Fillable Printable
Other-Youth Assent Cross Sectional Age 13 - 14 Social Media (Web)	Attachment 05f_Youth Assent_Cross Sectional Age 13 - 14_Social Media_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: 4,920	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	4,920	3,000	1,920
Annual IC Time Burden (Hours)	3,690	2,250	1,440
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.