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⚠️ Notice: This information collection may be referencing outdated material.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

2025-03-28 - No material or nonsubstantive change to a currently approved collection
2024-09-24 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0910 Focus Group Screener Emerging Tobacco Products Communication Initiative Pre-testing of Ads	Form and Instruction
Form 0920-0910 Focus Group Moderator Guide Emerging Tobacco Products Communication Initiative Pre-testing of Ads	Form and Instruction
Form 0920-0910 Survey Eligibility Screener Emerging Tobacco Products Communication Initiative Pre-testing of Ads	Form and Instruction
Form 0920-0910 Survey Questionnaire 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

View Information Collection (IC)

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0910	Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0910	Yes	No	Fillable Fileable
Form and Instruction	0920-0910	Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0910	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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		10/01/2021
Focus Group Advance Logistics Letter		10/01/2021
Lucid Privacy Policy		10/01/2021
Survey Email Invite		10/01/2021
IRB		10/01/2021
Survey Questionnaire Screenshots		10/01/2021
SSA		10/01/2021
SSB		10/01/2021

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

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