Information Collection

Study to Improve Thyroid Doses from Fallout Exposure in Kazakhstan

IC 180668 under ICR 200706-0925-001 · OMB 0925-0582.

Documents and Forms

Document Name Document Type
Form 1 Study to Improve Thyroid Doses from Fallout Exposure in Kazakhstan Form
1 Focus Group Guide Appendix A- KAZ Men_FocusGroupGuide-5-14-07[1].pdf Form
2 Women Appendix B - KAZ Women_FocusGroupGuide_InSession-5-14-07[1].pdf Form
3 Not in Session Appendix C - KAZ Women_FocusGroupGuide_NOTInSession-5-14-07[1].pdf Form
4 Evaluation Appendix D - KAZ Post_FocusGroup_Evaluation_Apr2[1].pdf Form
Appendix E1-IRB Approval-RTI_Apr2[1].pdf Appendix E1-IRB Approval-RTI_Apr2[1] IC Document
Appendix E2-IRB Approval-SSMA.pdf Appendix E2-IRB Approval-SSMA IC Document
Appendix F - KAZ Consent Form_Apr2.pdf Appendix F - KAZ Consent Form_Apr2 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Study to Improve Thyroid Doses from Fallout Exposure in Kazakhstan	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Focus Group Guide	Appendix A- KAZ Men_FocusGroupGuide-5-14-07[1].pdf	Yes	Yes	Paper Only
Form	2	Women	Appendix B - KAZ Women_FocusGroupGuide_InSession-5-14-07[1].pdf	Yes	Yes	Paper Only
Form	3	Not in Session	Appendix C - KAZ Women_FocusGroupGuide_NOTInSession-5-14-07[1].pdf	Yes	Yes	Paper Only
Form	4	Evaluation	Appendix D - KAZ Post_FocusGroup_Evaluation_Apr2[1].pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 128	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	128	128
Annual IC Time Burden (Hours)	256	256
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix E1-IRB Approval-RTI_Apr2[1]	Appendix E1-IRB Approval-RTI_Apr2[1].pdf	05/31/2007
Appendix E2-IRB Approval-SSMA	Appendix E2-IRB Approval-SSMA.pdf	05/31/2007
Appendix F - KAZ Consent Form_Apr2	Appendix F - KAZ Consent Form_Apr2.pdf	05/31/2007

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