Information Collection

Health Provider Formative Focus Group Testing for the Inside Knowledge: Get the Facts about Gynecologic Cancer Campaign

IC 197402 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⚠️ Notice: This information collection may be referencing outdated material.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
Health Provider Formative Focus Group Testing for the Inside Knowledge: Get the Facts about Gynecologic Cancer Campaign	Form and Instruction
Screener for Gynecologists IC 4_Att 1_Screener for Gynecologists 4 14 2011.doc	Form and Instruction
Screener for Primary Care Providers IC 4_Att 2_Screener for Primary Care Providers 4 14 2011.doc	Form and Instruction
Moderator Guide IC 4_Att 4_Moderators Guide 4.14.11.doc	Form and Instruction
IC 4_Att 3_Consent Form 4 14 2011.doc Consent	IC Document
IC 4_Justification 4 14 2011.doc Supporting Statement	IC Document

IC Title:

Health Provider Formative Focus Group 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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Screener for Gynecologists	IC 4_Att 1_Screener for Gynecologists 4 14 2011.doc	No	No	Fillable Fileable
Form and Instruction	none	Screener for Primary Care Providers	IC 4_Att 2_Screener for Primary Care Providers 4 14 2011.doc	No	No	Fillable Fileable
Form and Instruction	none	Moderator Guide	IC 4_Att 4_Moderators Guide 4.14.11.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 720

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 67 %

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	720	0	0	0	0	0
Annual IC Time Burden (Hours)	384	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
Consent	IC 4_Att 3_Consent Form 4 14 2011.doc	04/14/2011
Supporting Statement	IC 4_Justification 4 14 2011.doc	04/14/2011

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