National Tobacco Education Campaign Rough Cut Testing of Television Advertisements

Message Testing for Tobacco Communication Activities

⚠️ Notice: This information collection may be referencing outdated material.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
National Tobacco Education Campaign Rough Cut Testing of Television Advertisements Form and Instruction
Online Questionnaire Recruitment Screener Att 2- Online Questionnaire Recruitment Screener Rough Cut Testing.docx Form and Instruction
Online Questionnaire Att 4 - Online Questionnaire Main Screen Shots Rough Cut Testing.pdf Form and Instruction
Online Questionnaire Recruitment Screener / Questionnair Att 4 - Online Questionnaire Main Screen Shots Rough Cut Testing.pdf Form and Instruction
Part A_Rough Cut Testing_0921 (002).docx Supporting Statement A IC Document
Part B_Rough Cut Testing_0919.docx Supporting Statement B IC Document
Att 1 - Online Questionnaire Email Invitation to Potential Respondents_Rough Cut Testing_2018 Tips Campaign.docx Online Questionnaire Email Invitation IC Document
Att 5 - Toluna Terms and Conditions_Rough Cut Testing.docx Toluna - Terms and Conditions IC Document
Att 7 - Toluna Privacy Policy_Rough Cut Testing_2018 Tips Campaign.docx Toluna Privacy Policy IC Document
Att 6 - Battelle IRB Approval.pdf Batelle - IRB Approval IC Document
Att 8 - Research Determination.pdf Research Determination IC Document
Sure Link Info_National Tobacco Education Campaign.docx National Tobacco Education Campaign - Link/Password IC Document

Information Collection (IC) Details

IC Title:	National Tobacco Education Campaign Rough Cut Testing of Television Advertisements	Agency IC Tracking Number:	0920-0910-17BCZ

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 and Instruction	NA	Online Questionnaire Recruitment Screener	Att 2- Online Questionnaire Recruitment Screener Rough Cut Testing.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Online Questionnaire	Att 4 - Online Questionnaire Main Screen Shots Rough Cut Testing.pdf	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Online Questionnaire Recruitment Screener / Questionnaire - Screenshots	Att 4 - Online Questionnaire Main Screen Shots Rough Cut Testing.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,670	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,670	10,670
Annual IC Time Burden (Hours)	1,222	1,222
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	Part A_Rough Cut Testing_0921 (002).docx	10/12/2017
Supporting Statement B	Part B_Rough Cut Testing_0919.docx	10/12/2017
Online Questionnaire Email Invitation	Att 1 - Online Questionnaire Email Invitation to Potential Respondents_Rough Cut Testing_2018 Tips Campaign.docx	10/12/2017
Toluna - Terms and Conditions	Att 5 - Toluna Terms and Conditions_Rough Cut Testing.docx	10/12/2017
Toluna Privacy Policy	Att 7 - Toluna Privacy Policy_Rough Cut Testing_2018 Tips Campaign.docx	10/12/2017
Batelle - IRB Approval	Att 6 - Battelle IRB Approval.pdf	10/12/2017
Research Determination	Att 8 - Research Determination.pdf	10/12/2017
National Tobacco Education Campaign - Link/Password	Sure Link Info_National Tobacco Education Campaign.docx	10/13/2017

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