Information Collection

Emerging Tobacco Products Communication Initiative Pre-testing of Ads

IC 249570 under ICR 202009-0920-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0910 Emerging Tobacco Products Communication Initiative Pre-testing of Ads	Form and Instruction
0910 Att 3 Focus Group Consent Frm.docx	Instruction
0910 Att 10 Survey Questionnaire Consent Frm.docx	Instruction
0920-0910 Focus Group Screener Attachment 1 Focus Group Recruitment Screener (9.28.21).docx	Form and Instruction
0920-0910 Focus Group Moderator Guide 0910 Att 5 Focus Group Mod Guide.docx	Form and Instruction
0920-0910 Survey Eligibility Screener Attachment 9 Survey Questionnaire Eligibility Screener (9.24.21).docx	Form and Instruction
0920-0910 Survey Questionnaire 0910 Att 6 Survey Questionnaire.docx	Form and Instruction
0910 Att 2 Limelight Privacy Policy.pdf Limelight Privacy Policy	IC Document
0910 Att 4 Focus Group Advance Logistics Ltr.docx Focus Group Advance Logistics Letter	IC Document
0910 Att 7 Lucid Privacy Policy & TOS.pdf Lucid Privacy Policy	IC Document
0910 Att 8 Survey Questionnaire Email Invite.docx Survey Email Invite	IC Document
0910 Att 12 RTI IRB Approval.pdf IRB	IC Document
Attachment 11 - Survey Questionnaire Sample Screenshots (9.29.21).pptx Survey Questionnaire Screenshots	IC Document
0910 SSA_final.docx SSA	IC Document
0910 SSB.docx SSB	IC Document

IC Title:

Emerging Tobacco Products Communication Initiative Pre-testing of Ads

Agency IC Tracking Number:

0920-0910-21II

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	0920-0910	Focus Group Screener	Attachment 1 Focus Group Recruitment Screener (9.28.21).docx	Yes	Yes	Fillable Fileable
Instruction			0910 Att 3 Focus Group Consent Frm.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0910	Focus Group Moderator Guide	0910 Att 5 Focus Group Mod Guide.docx	Yes	No	Fillable Fileable
Form and Instruction	0920-0910	Survey Eligibility Screener	Attachment 9 Survey Questionnaire Eligibility Screener (9.24.21).docx	Yes	Yes	Fillable Fileable
Instruction			0910 Att 10 Survey Questionnaire Consent Frm.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0910	Survey Questionnaire	0910 Att 6 Survey Questionnaire.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,848

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,848	9,848
Annual IC Time Burden (Hours)	609	609
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Limelight Privacy Policy	0910 Att 2 Limelight Privacy Policy.pdf	10/01/2021
Focus Group Advance Logistics Letter	0910 Att 4 Focus Group Advance Logistics Ltr.docx	10/01/2021
Lucid Privacy Policy	0910 Att 7 Lucid Privacy Policy & TOS.pdf	10/01/2021
Survey Email Invite	0910 Att 8 Survey Questionnaire Email Invite.docx	10/01/2021
IRB	0910 Att 12 RTI IRB Approval.pdf	10/01/2021
Survey Questionnaire Screenshots	Attachment 11 - Survey Questionnaire Sample Screenshots (9.29.21).pptx	10/01/2021
SSA	0910 SSA_final.docx	10/01/2021
SSB	0910 SSB.docx	10/01/2021

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