Information Collection

Concept Testing for the Inside Knowledge: Get the Facts about Gynecologic Cancer Campaign

IC 190099 under ICR 200906-0920-015 · OMB 0920-0800.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0800 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Concept Testing for the Inside Knowledge: Get the Facts about Gynecologic Cancer Campaign	Form
Moderator Disucssion Guide Moderators Guide for Gyn Concept Testing 7 06 09.doc	Form
Participant Screener for GYN Concept Testing 7 06 09.doc Screening Form	IC Document
Participant Consent Form.doc Consent Document	IC Document
Test Print Ads for Gyn Cancer.pdf Print ads	IC Document
Test PSA Storyboards for Gyn Cancer.pdf PSA Storyboards	IC Document
Change Request for Gyn Concept Testing 7 06 09.doc Justification for Generic IC Request	IC Document

IC Title:

Concept Testing for the Inside Knowledge: Get the Facts about Gynecologic Cancer Campaign

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	none	Moderator Disucssion Guide	Moderators Guide for Gyn Concept Testing 7 06 09.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 648

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	648	0	0	0	0	0
Annual IC Time Burden (Hours)	346	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
Screening Form	Participant Screener for GYN Concept Testing 7 06 09.doc	07/13/2009
Consent Document	Participant Consent Form.doc	07/13/2009
Print ads	Test Print Ads for Gyn Cancer.pdf	07/13/2009
PSA Storyboards	Test PSA Storyboards for Gyn Cancer.pdf	07/13/2009
Justification for Generic IC Request	Change Request for Gyn Concept Testing 7 06 09.doc	07/13/2009

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