Information Collection

Web-based Survey to Communicate Cancer

IC 186833 under ICR 200810-0925-002 · OMB 0925-0046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form #1 Web-based Survey to Communicate Cancer	Form and Instruction
Form #1 HAN Risk Survey OMB Han RISK Survey Rev _ 5-15-08.doc	Form and Instruction
Mini Supporting Statement Han RISK Rev _5-15-08.doc Mini Supporting Statement for the HAN Risk Survey	IC Document

IC Title:

Web-based Survey to Communicate Cancer

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form #1	HAN Risk Survey	OMB Han RISK Survey Rev _ 5-15-08.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	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	200	0	0	0	0	0
Annual IC Time Burden (Hours)	40	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mini Supporting Statement for the HAN Risk Survey	Mini Supporting Statement Han RISK Rev _5-15-08.doc	10/07/2008

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