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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.