LGBT young adults media tracking screener

Food and Drug Administration's Research and Evaluation Survey for the Public Education Campaign on Tobacco among LGBT (RESPECT)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0808 can be found here:

Documents and Forms

Document Name Document Type
Attachment5_ScreenerInformedConsent FU2.docx Other-Screener Informed Consent
Attachment 03 New Participant Screener_FU5.docx Other-Screener

Information Collection (IC) Details

IC Title:	LGBT young adults media tracking screener	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-Screener Informed Consent			Attachment5_ScreenerInformedConsent FU2.docx		Yes	Yes	Fillable Fileable
Other-Screener			Attachment 03 New Participant Screener_FU5.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,668	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,668	1,668
Annual IC Time Burden (Hours)	138	138
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.