Information Collection

[NCCDPHP] National Tobacco Education Campaign Rough-Cut Testing of Television Advertisements - Cycle 3

IC 272205 under ICR 202409-0920-018 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0910 [NCCDPHP] National Tobacco Education Campaign Rough-Cut Testing of Television Advertisements - Cycle 3 Form and Instruction
0920-0910 Onlline Recruitment Screener Att 2 - Recruitment Screener_Cycle 3 Rough Cut Testing_20241004.docx Form and Instruction
0920-0910 Onlline Questionnaire Att 3 - Questionnaire_Cycle 3 Rough Cut Testing_20241004.docx Form and Instruction
Att 1 - Invitation Email_Cycle 3 Rough Cut Testing_20240725.docx Invitation Email IC Document
Att 4 - Online Questionnaire Screenshots_Rough Cut Testing_20241007.docx Online Questionnaire - screenshots IC Document
Att 5 - Panel Terms and Conditions_Cycle 3 Rough Cut Testing_20240725.pdf Panel Terms and Conditions IC Document
Att 7 - Panel Privacy Policies_Cycle 3 Rough Cut Testing_20240725.pdf Panel Privacy Policies IC Document
Att 6 - Notice of Exemption IRB 0840 Rev 3.0 Cycle 3 Rough Cut Testing.Sept 2024.pdf IRB Exemption IC Document
Secure link for the TV scripts.docx Secure Link for TV scripts IC Document
Supporting Statement A_Cycle 3 Rough Cut Testing_20241004.docx Supporting Statement A IC Document
Supporting Statement B_Cycle 3 Rough Cut Testing_20241004.docx Supporting Statement B IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[NCCDPHP] National Tobacco Education Campaign Rough-Cut Testing of Television Advertisements - Cycle 3	Agency IC Tracking Number:	0920-0910-25AZ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0910	Onlline Recruitment Screener	Att 2 - Recruitment Screener_Cycle 3 Rough Cut Testing_20241004.docx	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0910	Onlline Questionnaire	Att 3 - Questionnaire_Cycle 3 Rough Cut Testing_20241004.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24,714	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	24,714	24,714
Annual IC Time Burden (Hours)	2,833	2,833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Invitation Email	Att 1 - Invitation Email_Cycle 3 Rough Cut Testing_20240725.docx	11/07/2024
Online Questionnaire - screenshots	Att 4 - Online Questionnaire Screenshots_Rough Cut Testing_20241007.docx	11/07/2024
Panel Terms and Conditions	Att 5 - Panel Terms and Conditions_Cycle 3 Rough Cut Testing_20240725.pdf	11/07/2024
Panel Privacy Policies	Att 7 - Panel Privacy Policies_Cycle 3 Rough Cut Testing_20240725.pdf	11/07/2024
IRB Exemption	Att 6 - Notice of Exemption IRB 0840 Rev 3.0 Cycle 3 Rough Cut Testing.Sept 2024.pdf	11/07/2024
Secure Link for TV scripts	Secure link for the TV scripts.docx	11/07/2024
Supporting Statement A	Supporting Statement A_Cycle 3 Rough Cut Testing_20241004.docx	11/07/2024
Supporting Statement B	Supporting Statement B_Cycle 3 Rough Cut Testing_20241004.docx	11/07/2024

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