Information Collection

Copy Testing of Television and Print Ads

IC 212653 under ICR 201312-0920-001 · OMB 0920-0910.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0910 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Copy Testing of Television and Print Ads	Form
Screener Att 1a - Survey Screener Subpopulation v20.doc	Form
Survey Att 1b - Survey Main Subpopulations v20.docx	Form
Survey Screenshots Att 5_Screenshots v6 0 IC#12.pdf	Form
Part A_GenIC 12_Copy test v24 08112014.docx SS Part A	IC Document
Part B_GenIC 12_Copy test v23 08112014 docx.docx Part B	IC Document
Att 3_Privacy Policy v4.0 06052014.docx Toluna Privacy Policy	IC Document
Att 4_Terms and Conditions v4.0 06052014.docx Toluna Terms	IC Document
Att 2_Email Recruitment v4.0 06052014.docx Email Recruitment	IC Document

IC Title:

Copy Testing of Television and Print Ads

Agency IC Tracking Number:

14AUL

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Screener	Att 1a - Survey Screener Subpopulation v20.doc	Yes	Yes	Fillable Fileable
Form	none	Survey	Att 1b - Survey Main Subpopulations v20.docx	Yes	Yes	Fillable Fileable
Form	none	Survey Screenshots	Att 5_Screenshots v6 0 IC#12.pdf	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	1,180	1,180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SS Part A	Part A_GenIC 12_Copy test v24 08112014.docx	08/13/2014
Part B	Part B_GenIC 12_Copy test v23 08112014 docx.docx	08/13/2014
Toluna Privacy Policy	Att 3_Privacy Policy v4.0 06052014.docx	08/13/2014
Toluna Terms	Att 4_Terms and Conditions v4.0 06052014.docx	08/13/2014
Email Recruitment	Att 2_Email Recruitment v4.0 06052014.docx	08/13/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.