Information Collection

National Tobacco Education Campaign: Creative Concept Testing

IC 226720 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⚠️ Notice: This information collection may be referencing outdated material.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:

2025-03-28 - No material or nonsubstantive change to a currently approved collection
2024-09-24 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
National Tobacco Education Campaign: Creative Concept Testing	Form and Instruction
Recruitment Screener for Online Questionnaire Att 2 - Online Questionnaire Recruitment Screener_V2_CLEAN COPY.DOCX	Form and Instruction
Online Questionnaire Att3-Online Questionnaire Main.docx	Form and Instruction
Focus Group Screener Att 4 - Focus Group Recruitment Screener (Telephone Screener)_12 21 16_C....docx	Form and Instruction
Pre-Focus Group Questionnaire and Informed Consent Att 5 - Pre-Focus Group Questionnaire and Informed Consent_1 13 17.docx	Form and Instruction
Focus Group Moderator Guide - Exclusive Smokers Att 6 - Focus Group Moderator's Guide - Exclusive Smokers_1 13 17.docx	Form and Instruction
Focus Group Moderator Guide - Dual User Att 7 - Focus Group Moderator's Guide - Dual Users_1 13 17.docx	Form and Instruction
Participant Feedback Questionnaire Att 8 - Participant Feedback Questionnaire_12 21 16_CLEAN.DOCX	Form and Instruction
Att 1 - Online Questionnaire Email Invitation to Potential Respondents.docx Online Questionnaire Email Invitation	IC Document
Att 9 - Toluna Terms and Conditions_NO CHANGE.DOCX Toluna USA Membership Site - Terms and Conditions	IC Document
Att 10 - IRB Approval.pdf IRB Approval - Battelle	IC Document
Att 11 - Toluna Privacy Policy.docx Toluna USA - Privacy Policy	IC Document
Att 12 - Schlesinger Privacy Policy.docx Schlesinger Associates - Privacy Policy	IC Document
Part A - Creative Concepts_05MAY2017.docx Supporting Statement A - 05MAY2017	IC Document
Part B - Creative Concepts_05MAY2017.docx Supporting Statement B - 05MAY2017	IC Document
Creative Concept Testing - Secure Website Link.docx Creative Concept Testing - Secure Website Link	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

National Tobacco Education Campaign: Creative Concept Testing

Agency IC Tracking Number:

17QV

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 and Instruction	NA	Recruitment Screener for Online Questionnaire	Att 2 - Online Questionnaire Recruitment Screener_V2_CLEAN COPY.DOCX	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Online Questionnaire	Att3-Online Questionnaire Main.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Focus Group Screener	Att 4 - Focus Group Recruitment Screener (Telephone Screener)_12 21 16_C....docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Pre-Focus Group Questionnaire and Informed Consent	Att 5 - Pre-Focus Group Questionnaire and Informed Consent_1 13 17.docx	NA	No		Paper Only
Form and Instruction	NA	Focus Group Moderator Guide - Exclusive Smokers	Att 6 - Focus Group Moderator's Guide - Exclusive Smokers_1 13 17.docx	NA	No		Paper Only
Form and Instruction	NA	Focus Group Moderator Guide - Dual User	Att 7 - Focus Group Moderator's Guide - Dual Users_1 13 17.docx	NA	No		Paper Only
Form and Instruction	NA	Participant Feedback Questionnaire	Att 8 - Participant Feedback Questionnaire_12 21 16_CLEAN.DOCX	NA	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 27,692

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 85 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	27,692	27,692
Annual IC Time Burden (Hours)	3,109	3,109
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Online Questionnaire Email Invitation	Att 1 - Online Questionnaire Email Invitation to Potential Respondents.docx	05/05/2017
Toluna USA Membership Site - Terms and Conditions	Att 9 - Toluna Terms and Conditions_NO CHANGE.DOCX	05/05/2017
IRB Approval - Battelle	Att 10 - IRB Approval.pdf	05/05/2017
Toluna USA - Privacy Policy	Att 11 - Toluna Privacy Policy.docx	05/05/2017
Schlesinger Associates - Privacy Policy	Att 12 - Schlesinger Privacy Policy.docx	05/05/2017
Supporting Statement A - 05MAY2017	Part A - Creative Concepts_05MAY2017.docx	05/05/2017
Supporting Statement B - 05MAY2017	Part B - Creative Concepts_05MAY2017.docx	05/05/2017
Creative Concept Testing - Secure Website Link	Creative Concept Testing - Secure Website Link.docx	05/05/2017

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