View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

National Tobacco Education Campaign: Rough Cut Testing of TV, Print, and Radio Ads
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Screener for General Pop. and AI/AN Att 1(e) Screener-GenPop_AI-AN_2012_11_28.doc Yes Yes Fillable Fileable
Form none Screener for Spanish Speaking Hispanics Att 2(e) Screener_Spanish Speaking Hispanics (in English)_2012_11_28.doc Yes Yes Fillable Fileable
Form none Screener for Spanish Speaking Hispanics - Spanish Att 2(s) Screener_Spanish Speaking Hispanics (in Spanish)_2012_11_28.doc Yes Yes Fillable Fileable
Form none Main Questionnaire - English Att 3(e) Main Questionnaire (in English)_2012_11_28.doc Yes Yes Fillable Fileable
Form none Main Questionnaire - Spanish Att 3(s) Main Questionnaire (in Spanish)_2012_11_28.doc Yes Yes Fillable Fileable

Health Immunization Management

 

21,900 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 21,900 0 0 0 0 0
Annual IC Time Burden (Hours) 2,050 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 4(e) - Email to Participants - English Att 4(e) Emails To Participants (in English).docx 11/29/2012
Att 4(s) - Email to Participants - Spanish Att 4(s) Emails To Participants (in Spanish).docx 11/29/2012
Att 5(e) - Privacy Policy -English Att 5 (e) Privacy Policies.docx 11/29/2012
Att 5(s) - Privacy Policy - Spanish Att 5 (s) Privacy Policies.docx 11/29/2012
Att 6(e) - Terms of Use - English Att 6 (e) Terms Of Use-Terms Conditions.docx 11/29/2012
Att 6(s) - Terms of Use - Spanish Att 6 (s) Terms Of Use-Terms Conditions.docx 11/29/2012
Supporting Statement A 0920-0910_IC_4_Part A_2012_11_28.docx 11/29/2012
Supporting Statement B 0920-0910_IC_4_Part B_2012 11 28.docx 11/29/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.