Information Collection

Message Platform Testing for Regular Cigarettes and Dual Use

IC 222433 under ICR 201412-0920-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Att 1A. Screenshots_042016 Screener.pdf	Other-Screenshots
Att 1B. Screenshots_05252016 Main.pdf	Other-Screenshots
Att 2A Moderator's Guide Dual Use_07 11_2016_OSH_clean.docx	Other-WORD
Att 3A Moderator's Guide Cigarette Smokers_07 11_2016_OSH_clean.docx	Other-WORD
Part A_Message Platform_07112016_clean.docx Supporting Statement A	IC Document
Part B_Message Platform_07 11 2016.docx Supporting Statement B	IC Document
Att 4. Email Recruitment_05 13 2016.docx Att 4_Email Recruitment	IC Document
Att 5. Terms and Conditions_05 13 2016.docx Att 5_Terms and Conditions	IC Document
Att 6. Privacy Policy_05 13 2016.docx Att 6_Privacy Policy	IC Document
Att 7. IRB Approval Notice_V1 04 26 2016.pdf Att 7_IRB Approval	IC Document

IC Title:

Message Platform Testing for Regular Cigarettes and Dual Use

Agency IC Tracking Number:

16AVE

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots	Att 1A. Screenshots_042016 Screener.pdf	Yes	Yes	Fillable Fileable
Other-Screenshots	Att 1B. Screenshots_05252016 Main.pdf	Yes	Yes	Fillable Fileable
Other-WORD	Att 2A Moderator's Guide Dual Use_07 11_2016_OSH_clean.docx	No		Paper Only
Other-WORD	Att 3A Moderator's Guide Cigarette Smokers_07 11_2016_OSH_clean.docx	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16,000

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	16,000	16,000
Annual IC Time Burden (Hours)	3,146	3,146
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	Part A_Message Platform_07112016_clean.docx	07/13/2016
Supporting Statement B	Part B_Message Platform_07 11 2016.docx	07/13/2016
Att 4_Email Recruitment	Att 4. Email Recruitment_05 13 2016.docx	07/13/2016
Att 5_Terms and Conditions	Att 5. Terms and Conditions_05 13 2016.docx	07/13/2016
Att 6_Privacy Policy	Att 6. Privacy Policy_05 13 2016.docx	07/13/2016
Att 7_IRB Approval	Att 7. IRB Approval Notice_V1 04 26 2016.pdf	07/13/2016

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