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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
National Tobacco Education Campaign: Rough-Cut Testing of Television Advertisements
Agency IC Tracking Number:
0920-0910-22IQ
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
Online Questionnaire Recruitment Screener for Rough Cut Testing of Television Advertisements
Att 2 - Online Questionnaire Recruitment Screener_Rough Cut Testing.docx
Yes
Yes
Fillable Fileable
Form
0920-0910
Online Questionnaire for Rough Cut Testing of Television Advertisements
Att 3_Online Main Questionnaire_Rough Cut Testing clean.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
120,815
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
120,815
0
120,815
0
0
0
Annual IC Time Burden (Hours)
13,844
0
13,844
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Toluna USA Membership Site Terms
Att 5 - Toluna Terms and Conditions_Rough Cut Testing_20220602.pdf
09/02/2022
Online Questionnaire Screenshots
Att 4 2022 Online Questionniare Screenshots 20220617.pdf
09/02/2022
Battelle Institutional Review Board Approval
Att 6 - Battelle Institutional Review Board Approval_20220602.pdf
09/02/2022
Toluna Privacy Policy
Att 7 - Toluna Privacy Policy_Rough Cut Testing_20220602.pdf
09/02/2022
Email Invitation to Potential Respondents
Att 1 - Email Invitation to Potential Respondents_Rough-Cut Testing_20220602.pdf
09/02/2022
Supporting Statement A
Part A_Rough Cut Testing.docx
09/07/2022
Supporting Statement B
Part B_Rough Cut Testing.docx
09/07/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.