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Bundled sub-studies #17 (CIS) and #18 (Message)
Formative Research, Pretesting, and Customer Satisfaction of NCI's Communication and Education Resources (NCI)
OMB: 0925-0046
IC ID: 198803
OMB.report
HHS/NIH
OMB 0925-0046
ICR 201008-0925-004
IC 198803
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0046 can be found here:
2022-10-25 - Extension without change of a currently approved collection
2019-07-30 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
Bundled sub-studies #17 (CIS) and #18 (Message)
Form and Instruction
1 #17 Email Form and Survey
#17_Attach 17C Email Form and 17D Survey_CIS.docx
Form and Instruction
2 #18 Moderator's Guide and Screener
#18_Attach 18B guide & 18C Screener.docx
Form and Instruction
Memo to OMB_Key To Bundle #17 & 18.doc
Memo to OMB_Key To Bundle #17 & 18
IC Document
#17 and #18_Gen Sub-Study Form_CIS and Message.doc
#17 and #18_Gen Sub-Study Form_CIS and Message
IC Document
#17_Justif memo & Attach 17A and17 B_CIS_7-27-2011.docx
#17_Justif memo & Attach 17A and17 B_CIS_7-27-2011
IC Document
#18_Justif Memo & Attach 18A Themes 18D Consent_Message.doc
#18_Justif Memo & Attach 18A Themes 18D Consent_Message
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Bundled sub-studies #17 (CIS) and #18 (Message)
Agency IC Tracking Number:
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1
#17 Email Form and Survey
#17_Attach 17C Email Form and 17D Survey_CIS.docx
Yes
Yes
Fillable Fileable
Form and Instruction
2
#18 Moderator's Guide and Screener
#18_Attach 18B guide & 18C Screener.docx
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
SORN #09-25-0156, "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"
FR Citation:
67 FR 60743
Number of Respondents:
335
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
60 %
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
335
0
0
0
0
0
Annual IC Time Burden (Hours)
156
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Memo to OMB_Key To Bundle #17 & 18
Memo to OMB_Key To Bundle #17 & 18.doc
07/27/2011
#17 and #18_Gen Sub-Study Form_CIS and Message
#17 and #18_Gen Sub-Study Form_CIS and Message.doc
07/27/2011
#17_Justif memo & Attach 17A and17 B_CIS_7-27-2011
#17_Justif memo & Attach 17A and17 B_CIS_7-27-2011.docx
07/27/2011
#18_Justif Memo & Attach 18A Themes 18D Consent_Message
#18_Justif Memo & Attach 18A Themes 18D Consent_Message.doc
07/27/2011
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.