Information Collection

National Tobacco Education Campaign Rough Cut Testing of Television Advertisements

IC 228614 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.