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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.