Information Collection

Rough Cut Testing of Television Advertisements

IC 233919 under ICR 201803-0920-021 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Television Advertisements	Form
Screener Att 2 - Online Questionnaire Recruitment Screener_Rough Cut Testing 2019....docx	Form
Questionnaire Att 3 - Online Questionnaire_Rough Cut Testing 2019_ 9 14 18_3.docx	Form
Rough cut screenshots Att 4_Rough cut testing 2019_screenshots.pdf	Form
Att 1 - Online Questionnaire Email Invitation to Potential Respondents_R....docx Email invitation	IC Document
Att 5 - Toluna Terms and Conditions_Rough Cut Testing 2019.docx Toluna Terms and Conditions	IC Document
Att 7 - Toluna Privacy Policy_Rough Cut Testing 2019.docx Toluna Privacy Policy	IC Document
Att. 6_Rough cut testing 2019_IRB approval.pdf Batelle IRB Approval	IC Document
Part A_Rough Cut Testing tsl 102618.docx Supporting Statement A	IC Document
Part B_Rough Cut Testing 2019 tsl 102618.docx Supporting Statement B	IC Document
PIA Form_2019 Rough Cut Testing 10 9 18.pdf PIA form	IC Document

IC Title:

Rough Cut Testing of Television Advertisements

Agency IC Tracking Number:

0920-0910-19DI

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Screener	Att 2 - Online Questionnaire Recruitment Screener_Rough Cut Testing 2019....docx	Yes	Yes	Fillable Fileable
Form	none	Questionnaire	Att 3 - Online Questionnaire_Rough Cut Testing 2019_ 9 14 18_3.docx	Yes	Yes	Fillable Fileable
Form	none	Rough cut screenshots	Att 4_Rough cut testing 2019_screenshots.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: 42,712

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	42,712	42,712
Annual IC Time Burden (Hours)	4,896	4,896
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email invitation	Att 1 - Online Questionnaire Email Invitation to Potential Respondents_R....docx	11/06/2018
Toluna Terms and Conditions	Att 5 - Toluna Terms and Conditions_Rough Cut Testing 2019.docx	11/06/2018
Toluna Privacy Policy	Att 7 - Toluna Privacy Policy_Rough Cut Testing 2019.docx	11/06/2018
Batelle IRB Approval	Att. 6_Rough cut testing 2019_IRB approval.pdf	11/06/2018
Supporting Statement A	Part A_Rough Cut Testing tsl 102618.docx	11/06/2018
Supporting Statement B	Part B_Rough Cut Testing 2019 tsl 102618.docx	11/06/2018
PIA form	PIA Form_2019 Rough Cut Testing 10 9 18.pdf	11/06/2018

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