Information Collection

National Tobacco Education Campaign: Rough-Cut Testing of Television, Radio, Print, and Digital Advertisements

IC 240009 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⚠️ Notice: This information collection may be referencing outdated material.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
National Tobacco Education Campaign: Rough-Cut Testing of Television, Radio, Print, and Digital Advertisements	Form and Instruction
Recruitment Screener 0920 0910 Att 2 Recuritment Screener_Rough Cut Testing 2020.docx	Form and Instruction
Online Questionnaire 0920 0910 Att 3 Online Questionnaire_Rough Cut Testing 2020.docx	Form and Instruction
Screenshots of the online Screener and Questionnaire 0920 0910 Att 4 - Online Questionnaire Main Screenshots.pdf	Form and Instruction
20200413_GIC 0910 SSA FINAL_clean_v4.docx Supporting Statement Part A	IC Document
20200413_GIC 0910 SSB FINAL_clean_v4.docx Supporting Statement Part B	IC Document
0920 0910 Att 1 - Online Questionnaire Email Invitation to Potential Respondents_Rough Cut Testing 2020.pdf Email Invitation to Participate	IC Document
0920 0910 Att 5 - Toluna Terms and Conditions_Rough Cut Testing 2020.pdf Toluna Terms and Conditions	IC Document
0920 0910 Att 7 - Toluna Privacy Policy_Rough Cut Testing 2020.pdf Toluna Privacy Policy	IC Document
0920 0910 Att 6 - IRB Approval Letter.pdf IRB Review Documentation	IC Document

IC Title:

National Tobacco Education Campaign: Rough-Cut Testing of Television, Radio, Print, and Digital Advertisements

Agency IC Tracking Number:

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 and Instruction	n/a	Recruitment Screener	0920 0910 Att 2 Recuritment Screener_Rough Cut Testing 2020.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Online Questionnaire	0920 0910 Att 3 Online Questionnaire_Rough Cut Testing 2020.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Screenshots of the online Screener and Questionnaire	0920 0910 Att 4 - Online Questionnaire Main 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: 20,116

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	20,116	20,116
Annual IC Time Burden (Hours)	4,195	4,195
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Part A	20200413_GIC 0910 SSA FINAL_clean_v4.docx	05/07/2020
Supporting Statement Part B	20200413_GIC 0910 SSB FINAL_clean_v4.docx	05/07/2020
Email Invitation to Participate	0920 0910 Att 1 - Online Questionnaire Email Invitation to Potential Respondents_Rough Cut Testing 2020.pdf	05/07/2020
Toluna Terms and Conditions	0920 0910 Att 5 - Toluna Terms and Conditions_Rough Cut Testing 2020.pdf	05/07/2020
Toluna Privacy Policy	0920 0910 Att 7 - Toluna Privacy Policy_Rough Cut Testing 2020.pdf	05/07/2020
IRB Review Documentation	0920 0910 Att 6 - IRB Approval Letter.pdf	05/07/2020

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