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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.