Emerging Tobacco Products Communication Initiative Pre-testing of Ads

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.