Information Collection

Rough Cut Testing of English Language Television, Radio, Print, and Digital Advertisements for the 2015 Tips Campaign

IC 213652 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Rough Cut Testing of English Language Television, Radio, Print, and Digital Advertisements for the 2015 Tips Campaign Form
Screenshots -Screener and Questionnaire Att 5_Screenshots for Gen IC #13 v7.0 10172014.pdf Form
GenIC 13_Part A v19_10 24 2014.docx SSA IC Document
GenIC 13_Part B v16_10 24 2014.docx SSB IC Document
Att 3_Privacy Policy v8.docx Privacy Policy IC Document
Att 4_Terms and Conditions v8.docx Terms and Conditions IC Document
Att 2_Email Recruitment Rough Cut Tests v8.docx Recruitment Email IC Document
Att 1a_ScreenerQuestionnaire Tips 2015 v8.docx Word Version - Screener IC Document
Att 1b_MainQuestionnaire Tips 2015 v9.docx Word Version Questionnaire IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rough Cut Testing of English Language Television, Radio, Print, and Digital Advertisements for the 2015 Tips Campaign	Agency IC Tracking Number:	15CS

IC Status: New

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
Form	none	Screenshots -Screener and Questionnaire	Att 5_Screenshots for Gen IC #13 v7.0 10172014.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11,667	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11,667	11,667
Annual IC Time Burden (Hours)	3,471	3,471
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA	GenIC 13_Part A v19_10 24 2014.docx	10/28/2014
SSB	GenIC 13_Part B v16_10 24 2014.docx	10/28/2014
Privacy Policy	Att 3_Privacy Policy v8.docx	10/28/2014
Terms and Conditions	Att 4_Terms and Conditions v8.docx	10/28/2014
Recruitment Email	Att 2_Email Recruitment Rough Cut Tests v8.docx	10/28/2014
Word Version - Screener	Att 1a_ScreenerQuestionnaire Tips 2015 v8.docx	10/29/2014
Word Version Questionnaire	Att 1b_MainQuestionnaire Tips 2015 v9.docx	10/29/2014

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