Fresh Empire Campaign: Wave 2 Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent Youth Tobacco Use

Generic Clearance for the Collection of Quantitative Data on Tobacco Products and Communications

OMB: 0910-0810

IC ID: 222137

Documents and Forms
Document Name
Document Type
Other-Screener (In-Person Electronic
Other-Screener (In-Person Paper)
Other-Screener (Social Media Electro
Other-Copy Testing Questionnaire
Other-Parental Opt-Out (In-Person)
Other-Parental Consent Form (In-Pers
Other-Parental Consent Verbal Script
Other-Parental Opt-Out (Social Media
Other-Participant Assent Form (In-Pe
Other-Participant Assent Form (Socia
Other-Social Media Advertisements
Other-Video Ad Stimuli
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Fresh Empire Campaign: Wave 2 Quantitative Study of Reactions to Rough-Cut Advertising Designed to Prevent Youth Tobacco Use CTP
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screener (In-Person Electronic) Attachment A - Screener (In-Person Electronic).docx Yes Yes Fillable Fileable
Other-Screener (In-Person Paper) Attachment B - Screener (In-Person Paper).pdf No   Paper Only
Other-Screener (Social Media Electronic) Attachment C - Screener (Social Media Electronic).docx Yes Yes Fillable Fileable
Other-Copy Testing Questionnaire Attachment D - Copy Testing Questionnaire.docx Yes Yes Fillable Fileable
Other-Parental Opt-Out (In-Person) Attachment E - Parental Opt-Out (In-Person).docx No   Paper Only
Other-Parental Consent Form (In-Person) Attachment F - Parental Consent Form (In-Person).docx No   Paper Only
Other-Parental Consent Verbal Script (In-Person) Attachment G - Parental Consent Verbal Script (In-Person).docx No   Paper Only
Other-Parental Opt-Out (Social Media) Attachment H - Parental Opt-Out (Social Media).docx Yes Yes Fillable Fileable
Other-Participant Assent Form (In-Person) Attachment I - Participant Assent Form (In-Person).docx Yes Yes Fillable Fileable
Other-Participant Assent Form (Social Media) Attachment J - Participant Assent Form (Social Media).docx Yes Yes Fillable Fileable
Other-Social Media Advertisements Attachment K - Social Media Advertisements.docx Yes No Printable Only
Other-Video Ad Stimuli Attachment L - Video Ad Stimuli.docx Yes No Printable Only

Health Consumer Health and Safety

 

19,310 0
   
Individuals or Households
 
   100 %

  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 19,310 0 0 0 0 19,310
Annual IC Time Burden (Hours) 1,531 0 0 0 0 1,531
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Part A - Quantitative Supporting Statement (Fresh Empire Campaign.Wave 2 Part A - Quantitative Supporting Statement (Fresh Empire Campaign.Wave 2.docx 06/23/2016
Part B - Quantitative Supporting Statement (Fresh Empire Campaign.Wave 2 Part B - Quantitative Supporting Statement (Fresh Empire Campaign.Wave 2.docx 06/23/2016
IRB Approval Letter Attachment M - IRB Approval Letter.pdf 06/23/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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