[NCIPC] Youth Audience Message Testing of Substance Use Prevention Messages

[OS] CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 268538

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Other-Consent
Other-Consent
Other-Consent
Other-Consent
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
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Information Collection (IC) Details

View Information Collection (IC)

[NCIPC] Youth Audience Message Testing of Substance Use Prevention Messages 0920-1154-24GK
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Parent and Child Screeners Attachment 1 - Screener_OIRA Feedback-YPulse-FM 07.29.2024 - clean 7.30.24.docx Yes No Fillable Fileable
Other-Consent Attachment 2 - Parent Legal Guardian Consent Form - 07.30.2024.docx Yes Yes Fillable Fileable
Other-Consent Attachment 3 - Youth Assent Form - 07.30.2024.docx Yes Yes Fillable Fileable
Form and Instruction n/a Activity Guide Attachment 4 - Activity Guide.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

638 0
   
Individuals or Households
 
   20 %

  Requested 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 638 0 0 0 0 638
Annual IC Time Burden (Hours) 256 0 0 0 0 256
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Programmed Activities Attachment 5-Progammed Activities.pdf 06/13/2024
Materials for Testing Attachment 6 - Materials for Testing.docx 06/13/2024
Privacy Agreement Attachment 7 - Privacy Agreement.docx 06/13/2024
PTA Attachment 7a-Youth Message Testing-PTA_01-08-2024 - Signed.pdf 06/13/2024
Research Determination Attachment 8 - IRB Determination Letter.pdf 06/13/2024
Recruitment and Follow Up Materials Attachment 9 - Recruitment & Follow Up Materials.docx 06/13/2024
SSA Supporting Statement A-Youth Message Testing 5.7 JK1-FM-5.13_final.docx 06/13/2024
SSB Supporting Statement B-Youth Message Testing.docx 06/13/2024
GenIC Request Template GenIC Request_Formative Research-Youth Message Testing_final.docx 06/13/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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