Testing and Evaluation of Tobacco Communication Activities

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Main Questionnaire in Vietnamese	Form	New	Available
Main Questionnaire in Spanish	Form	New	Available
Main Questionnaire in Korean	Form	New	Available
Main Questionnaire in Chinese	Form	New	Available
Screener in Vietnamese	Form	New	Available
Screener in Spanish	Form	New	Available
Screener in Korean	Form	New	Available
Screener in Chinese	Form	New	Available
Screenshots -Screener and Questionnaire	Form	New	Available
Survey Screenshots	Form	New	Available
Survey	Form	New	Available
Screener	Form	New	Repair queued
Screenshots of Survey Screener and Survey Main Questionnaire	Form	New	Available
5 - Screenshots of questionnaire	Form	New	Available
1b - Questionnaire - Spanish	Form	New	Available
1a - Screener - Spanish	Form	New	Available
Questionnaire	Form	New	Available
Screener	Form	New	Available
Survey screenshots	Form	New	Available
Screenshots	Form	New	Available
Main Questionnaire	Form	New	Available
Screener	Form	New	Available
0920-0910_SS_Part B_11 14 2013.docx	Supporting Statement B	Uploaded 2013-11-21	Available
684 Human Subjects Determination - RFTOP 2011-E-001.pdf	Supplementary Document	Uploaded 2013-11-21	Available
Attachment 5.docx	Supplementary Document	Uploaded 2013-11-21	Available
Att 4 Example screener and questionnaire.pdf	Supplementary Document	Uploaded 2013-11-21	Available
Att 3 Overview of Data Collection Methods.docx	Supplementary Document	Uploaded 2013-11-21	Available
Att 2b. Summary of Public Comments.doc	Supplementary Document	Uploaded 2013-11-21	Available
Att 1c. Public Health Service Act.doc	Supplementary Document	Uploaded 2013-11-21	Repair queued
0920-0910_SS_Part A_11 14 2013.docx	Supporting Statement A	Uploaded 2013-11-21	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213871	Rough Cut Testing of Spanish, Chinese, Korean, and Vietnamese Print Advertisements for the 2015 Tips Campaign	Form	New	Main Questionnaire in Vietnamese
213871	Rough Cut Testing of Spanish, Chinese, Korean, and Vietnamese Print Advertisements for the 2015 Tips Campaign	Form	New	Main Questionnaire in Spanish
213871	Rough Cut Testing of Spanish, Chinese, Korean, and Vietnamese Print Advertisements for the 2015 Tips Campaign	Form	New	Main Questionnaire in Korean
213871	Rough Cut Testing of Spanish, Chinese, Korean, and Vietnamese Print Advertisements for the 2015 Tips Campaign	Form	New	Main Questionnaire in Chinese
213871	Rough Cut Testing of Spanish, Chinese, Korean, and Vietnamese Print Advertisements for the 2015 Tips Campaign	Form	New	Screener in Vietnamese
213871	Rough Cut Testing of Spanish, Chinese, Korean, and Vietnamese Print Advertisements for the 2015 Tips Campaign	Form	New	Screener in Spanish
213871	Rough Cut Testing of Spanish, Chinese, Korean, and Vietnamese Print Advertisements for the 2015 Tips Campaign	Form	New	Screener in Korean
213871	Rough Cut Testing of Spanish, Chinese, Korean, and Vietnamese Print Advertisements for the 2015 Tips Campaign	Form	New	Screener in Chinese
213652	Rough Cut Testing of English Language Television, Radio, Print, and Digital Advertisements for the 2015 Tips Campaign	Form	New	Screenshots -Screener and Questionnaire
212653	Copy Testing of Television and Print Ads	Form	New	Survey Screenshots
212653	Copy Testing of Television and Print Ads	Form	New	Survey
212653	Copy Testing of Television and Print Ads	Form	New	Screener
212459	Message Platform Testing for Development of Future Advertising	Form	New	Screenshots of Survey Screener and Survey Main Questionnaire
212459	Message Platform Testing for Development of Future Advertising	Other-Interview Guide	New
210942	Rough Cut Testing of Spanish Language Television, Print, Digital Print, and Radio Ads for the Tips 2014 National Campaign	Form	New	5 - Screenshots of questionnaire
210942	Rough Cut Testing of Spanish Language Television, Print, Digital Print, and Radio Ads for the Tips 2014 National Campaign	Form	New	1b - Questionnaire - Spanish
210942	Rough Cut Testing of Spanish Language Television, Print, Digital Print, and Radio Ads for the Tips 2014 National Campaign	Form	New	1a - Screener - Spanish
210754	Rough Cut Testing of English Language Television, Print, Digital Print, and Radio Ads for the Tips 2014 National Campaign	Form	New	Questionnaire
210754	Rough Cut Testing of English Language Television, Print, Digital Print, and Radio Ads for the Tips 2014 National Campaign	Form	New	Screener
210754	Rough Cut Testing of English Language Television, Print, Digital Print, and Radio Ads for the Tips 2014 National Campaign	Form	New	Survey screenshots
210356	CopyTesting of Television Advertising	Form	New	Screenshots
210356	CopyTesting of Television Advertising	Form	New	Main Questionnaire
210356	CopyTesting of Television Advertising	Form	New	Screener
209931	Digital Media Copy Testing for Click-to-Call Ads	Other-Survey Screener	New

ICR Details

OMB Control No: 0920-0910	ICR Reference No: 201312-0920-001
Status: Historical Active	Previous ICR Reference No: 201109-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 20995
Title: Testing and Evaluation of Tobacco Communication Activities
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/02/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/02/2013
Terms of Clearance: Previous terms continue: CDC/OSH will submit a separate Information Collection Request to OMB that outlines the information collections needed to evaluate the ACA-funded tobacco communication campaign. The pre- and post-campaign surveys for campaign evaluation are related to developmental work to be conducted under the MTTCA generic clearance, however, these surveys will be conducted under a separate OMB control number.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	01/31/2015	01/31/2015
Responses	73,694	0	44,922
Time Burden (Hours)	14,438	0	17,325
Cost Burden (Dollars)	0	0	0

---

Abstract: The Center's for Disease Control and Prevention's Office on Smoking and Health (OSH) requests OMB approval of a revision to currnelty approved generic clearance to support a variety of information collections related to the development, implementation and evaluation of tobacco-related health messages and campaigns.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 399-V Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 111 - 31 387 Name of Law: Family Smoking Prevention and Tobacco Control Act
   US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 53461	08/29/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 69854	11/21/2013
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Copy Testing of Television and Print Ads	none, none, none	Screener ,   Survey ,   Survey Screenshots
CopyTesting of Television Advertising	none, none, none	Screener ,   Main Questionnaire ,   Screenshots
Digital Media Copy Testing for Click-to-Call Ads
Message Platform Testing for Development of Future Advertising	none	Screenshots of Survey Screener and Survey Main Questionnaire
Rough Cut Testing of English Language Television, Print, Digital Print, and Radio Ads for the Tips 2014 National Campaign	none, none, none	Survey screenshots ,   Screener ,   Questionnaire
Rough Cut Testing of English Language Television, Radio, Print, and Digital Advertisements for the 2015 Tips Campaign	none	Screenshots -Screener and Questionnaire
Rough Cut Testing of Spanish Language Television, Print, Digital Print, and Radio Ads for the Tips 2014 National Campaign	none, none, none	1a - Screener - Spanish ,   1b - Questionnaire - Spanish ,   5 - Screenshots of questionnaire
Rough Cut Testing of Spanish, Chinese, Korean, and Vietnamese Print Advertisements for the 2015 Tips Campaign	none, none, none, none, none, none, none, none	Screener in Chinese ,   Screener in Korean ,   Screener in Spanish ,   Screener in Vietnamese ,   Main Questionnaire in Chinese ,   Main Questionnaire in Korean ,   Main Questionnaire in Spanish ,   Main Questionnaire in Vietnamese

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	73,694	44,922	0	0	28,772	0
Annual Time Burden (Hours)	14,438	17,325	0	0	-2,887	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: In the original submission the program did not account for the number of responses that would be needed to screen potential participants for inclusion in message testing activities. This revision makes an adjustment to account for screening burden. They are also requesting modest increases in the number of responses and burden hours associated with surveys that support message development and testing. This revision does not change the current expiration date of the generic clearance, 1/31/2015.

---

Annual Cost to Federal Government: $33,909

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/02/2013

---