Information Collection

Sub-Study #3_NCI Cancer.gov Evolution - User Focus Groups and Triads

IC 193546 under ICR 201001-0925-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 2 Sub-Study #3_NCI Cancer.gov Evolution - User Focus Groups and Triads	Form and Instruction
2 #2_Attach 2_Mod Guide Triad #2_Attach 2_Mod Guide Triads_Cancer evol.docx	Form and Instruction
1 #2_Attach 1_Mod Guide Focus Group #2_Attach 1_Mod Guide Focus Groups_Cancer evol.doc	Form and Instruction
3 #2_Attach 3_Screener Patient-Friends-Family_Cancer evol #2_Attach 3_Screen Patient Friend Family_Cancer evol.doc	Form and Instruction
4 #2_Attach 4_Screener HCP Triad_Cancer evol #2_Attach 4_Screen HCP Triad_Cancer evol.doc	Form and Instruction
5 #2_Attach 5_Screener Research Triad_Cancer evol #2_Attach 5_Screen Research Triad_Cancer evol.doc	Form and Instruction
6 #2_Attach 6_Screener Advocate Triad_Cancer evol #2_Attach 6_Screen Advocate Triad_Cancer evol.docx	Form and Instruction
#2_Attach 7_Consent form_Cancer evol.doc #2_Attach 7_Consent Form	IC Document
#2_Justif memo_Cancer evol.doc #2_Justification Memo_Cancer evol	IC Document
#2_GC_Summary Form_0925-0046.doc #2_GC Summary Form_Cancer evolution	IC Document
#2_REV_Justif memo_Cancer evol_080610.doc #2 REVISED Justification memo Cancer evol	IC Document
#2_Attach 7_REV 2_Consent form_Cancer evol.doc #2 REVISED Consent Form Cancer evol	IC Document

IC Title:

Sub-Study #3_NCI Cancer.gov Evolution - User Focus Groups and Triads

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	2	#2_Attach 2_Mod Guide Triad	#2_Attach 2_Mod Guide Triads_Cancer evol.docx	Yes	No	Printable Only
Form and Instruction	1	#2_Attach 1_Mod Guide Focus Group	#2_Attach 1_Mod Guide Focus Groups_Cancer evol.doc	Yes	No	Printable Only
Form and Instruction	3	#2_Attach 3_Screener Patient-Friends-Family_Cancer evol	#2_Attach 3_Screen Patient Friend Family_Cancer evol.doc	Yes	No	Printable Only
Form and Instruction	4	#2_Attach 4_Screener HCP Triad_Cancer evol	#2_Attach 4_Screen HCP Triad_Cancer evol.doc	Yes	No	Printable Only
Form and Instruction	5	#2_Attach 5_Screener Research Triad_Cancer evol	#2_Attach 5_Screen Research Triad_Cancer evol.doc	Yes	No	Printable Only
Form and Instruction	6	#2_Attach 6_Screener Advocate Triad_Cancer evol	#2_Attach 6_Screen Advocate Triad_Cancer evol.docx	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

Number of Respondents for Small Entity: 80

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	80	0	0	0	0	0
Annual IC Time Burden (Hours)	103	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
#2_Attach 7_Consent Form	#2_Attach 7_Consent form_Cancer evol.doc	06/24/2010
#2_Justification Memo_Cancer evol	#2_Justif memo_Cancer evol.doc	06/30/2010
#2_GC Summary Form_Cancer evolution	#2_GC_Summary Form_0925-0046.doc	06/24/2010
#2 REVISED Justification memo Cancer evol	#2_REV_Justif memo_Cancer evol_080610.doc	08/13/2010
#2 REVISED Consent Form Cancer evol	#2_Attach 7_REV 2_Consent form_Cancer evol.doc	08/13/2010

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