Information Collection

National Tobacco Education Campaign: Creative Concept Testing

IC 226720 under ICR 201412-0920-008 · OMB 0920-0910.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0910 can be found here:

2025-03-28 - No material or nonsubstantive change to a currently approved collection
2024-09-24 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
National Tobacco Education Campaign: Creative Concept Testing Form and Instruction
Recruitment Screener for Online Questionnaire Att 2 - Online Questionnaire Recruitment Screener_V2_CLEAN COPY.DOCX Form and Instruction
Online Questionnaire Att3-Online Questionnaire Main.docx Form and Instruction
Focus Group Screener Att 4 - Focus Group Recruitment Screener (Telephone Screener)_12 21 16_C....docx Form and Instruction
Pre-Focus Group Questionnaire and Informed Consent Att 5 - Pre-Focus Group Questionnaire and Informed Consent_1 13 17.docx Form and Instruction
Focus Group Moderator Guide - Exclusive Smokers Att 6 - Focus Group Moderator's Guide - Exclusive Smokers_1 13 17.docx Form and Instruction
Focus Group Moderator Guide - Dual User Att 7 - Focus Group Moderator's Guide - Dual Users_1 13 17.docx Form and Instruction
Participant Feedback Questionnaire Att 8 - Participant Feedback Questionnaire_12 21 16_CLEAN.DOCX Form and Instruction
Att 1 - Online Questionnaire Email Invitation to Potential Respondents.docx Online Questionnaire Email Invitation IC Document
Att 9 - Toluna Terms and Conditions_NO CHANGE.DOCX Toluna USA Membership Site - Terms and Conditions IC Document
Att 10 - IRB Approval.pdf IRB Approval - Battelle IC Document
Att 11 - Toluna Privacy Policy.docx Toluna USA - Privacy Policy IC Document
Att 12 - Schlesinger Privacy Policy.docx Schlesinger Associates - Privacy Policy IC Document
Part A - Creative Concepts_05MAY2017.docx Supporting Statement A - 05MAY2017 IC Document
Part B - Creative Concepts_05MAY2017.docx Supporting Statement B - 05MAY2017 IC Document
Creative Concept Testing - Secure Website Link.docx Creative Concept Testing - Secure Website Link IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	National Tobacco Education Campaign: Creative Concept Testing	Agency IC Tracking Number:	17QV

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	NA	Recruitment Screener for Online Questionnaire	Att 2 - Online Questionnaire Recruitment Screener_V2_CLEAN COPY.DOCX	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Online Questionnaire	Att3-Online Questionnaire Main.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Focus Group Screener	Att 4 - Focus Group Recruitment Screener (Telephone Screener)_12 21 16_C....docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Pre-Focus Group Questionnaire and Informed Consent	Att 5 - Pre-Focus Group Questionnaire and Informed Consent_1 13 17.docx	NA	No		Paper Only
Form and Instruction	NA	Focus Group Moderator Guide - Exclusive Smokers	Att 6 - Focus Group Moderator's Guide - Exclusive Smokers_1 13 17.docx	NA	No		Paper Only
Form and Instruction	NA	Focus Group Moderator Guide - Dual User	Att 7 - Focus Group Moderator's Guide - Dual Users_1 13 17.docx	NA	No		Paper Only
Form and Instruction	NA	Participant Feedback Questionnaire	Att 8 - Participant Feedback Questionnaire_12 21 16_CLEAN.DOCX	NA	No		Paper Only

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: 27,692	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 85 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	27,692	27,692
Annual IC Time Burden (Hours)	3,109	3,109
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Online Questionnaire Email Invitation	Att 1 - Online Questionnaire Email Invitation to Potential Respondents.docx	05/05/2017
Toluna USA Membership Site - Terms and Conditions	Att 9 - Toluna Terms and Conditions_NO CHANGE.DOCX	05/05/2017
IRB Approval - Battelle	Att 10 - IRB Approval.pdf	05/05/2017
Toluna USA - Privacy Policy	Att 11 - Toluna Privacy Policy.docx	05/05/2017
Schlesinger Associates - Privacy Policy	Att 12 - Schlesinger Privacy Policy.docx	05/05/2017
Supporting Statement A - 05MAY2017	Part A - Creative Concepts_05MAY2017.docx	05/05/2017
Supporting Statement B - 05MAY2017	Part B - Creative Concepts_05MAY2017.docx	05/05/2017
Creative Concept Testing - Secure Website Link	Creative Concept Testing - Secure Website Link.docx	05/05/2017

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