Information Collection

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

IC 272205 under ICR 202503-0920-031 · OMB 0920-0910.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0910 [NCCDPHP] National Tobacco Education Campaign Rough-Cut Testing of Television Advertisements - Cycle 3	Form and Instruction
Form 0920-0910 Onlline Recruitment Screener [NCCDPHP] National Tobacco Education Campaign Rough-Cut Testing of Television Advertisements - Cycle 3	Form and Instruction
Form 0920-0910 Onlline Questionnaire [NCCDPHP] National Tobacco Education Campaign Rough-Cut Testing of Television Advertisements - Cycle 3	Form and Instruction
Form 0920-0910 Online Questionnaire for Rough Cut Testing of Television Advertisements REVISED 27MAR2025 [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 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
0920-0910 Onlline Questionnaire Att 3 - Questionnaire_Cycle 3 Rough Cut Testing_20241004.docx	Form and Instruction
0920-0910 Online Questionnaire for Rough Cut Testing of Television Att 3 - Questionnaire_Cycle 3 Rough Cut Testing_Clean Copy_20250318.docx	Form and Instruction
0920-0910 Online Questionnaire for Rough Cut Testing of Television Att 3 - Questionnaire_Cycle 3 Rough Cut Testing_Clean Copy_20250318.docx	Form and Instruction
Att 1 - Invitation Email_Cycle 3 Rough Cut Testing_20240725.docx Invitation Email	IC Document
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 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 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 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
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
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 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
Supporting Statement B_Cycle 3 Rough Cut Testing_20241004.docx Supporting Statement B	IC Document
Change Request Memo EO14168_Rough-Cut Testing Cyle 3_ 20250319.docx Non-Substantive Change Request Memo 27MAR2025	IC Document
Change Request Memo EO14168_Rough-Cut Testing Cyle 3_ 20250319.docx Non-Substantive Change Request Memo 27MAR2025	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: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0910	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0910	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0910	N/A	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: 24,714

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
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

table that charts IC Documents
Title	Document	Date Uploaded
Invitation Email		11/07/2024
Online Questionnaire - screenshots		11/07/2024
Panel Terms and Conditions		11/07/2024
Panel Privacy Policies		11/07/2024
IRB Exemption		11/07/2024
Secure Link for TV scripts		11/07/2024
Supporting Statement A		11/07/2024
Supporting Statement B		11/07/2024
Non-Substantive Change Request Memo 27MAR2025		03/26/2025

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

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