View Information Collection (IC)

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	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

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 %

	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	9,848	0	9,848	0	0	0
Annual IC Time Burden (Hours)	609	0	609	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	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.