Information Collection

Sub-study #18_Cancer Imaging Program (CIP) Web Site Usability Testing

IC 205054 under ICR 201108-0925-002 · OMB 0925-0642.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0642 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Sub-study #18_Cancer Imaging Program (CIP) Web Site Usability Testing	Form and Instruction
1 Screener Attach4_Screener_CIP.docx	Form and Instruction
2 Usability Test Attach5_UsabilityScript_CIP.doc	Form and Instruction
Attach2_VolunteerAnnounce_CIP.doc Attach2_VolunteerAnnounce_CIP	IC Document
Attach1_Consent_CIP.doc Attach1_Consent_CIP	IC Document
Attach3_RecruitLetters_CIP.docx Attach3_RecruitLetters_CIP	IC Document
Fast-Track_Request_Usability_Test_CIP.doc Fast-Track_Request_Usability_Test_CIP	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Sub-study #18_Cancer Imaging Program (CIP) Web Site Usability Testing

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	1	Screener	Attach4_Screener_CIP.docx		No	No	Printable Only
Form and Instruction	2	Usability Test	Attach5_UsabilityScript_CIP.doc		No	No	Printable Only

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: 74

Number of Respondents for Small Entity: 8

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

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	74	0	0	0	0	0
Annual IC Time Burden (Hours)	28	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
Attach2_VolunteerAnnounce_CIP	Attach2_VolunteerAnnounce_CIP.doc	12/03/2012
Attach1_Consent_CIP	Attach1_Consent_CIP.doc	12/03/2012
Attach3_RecruitLetters_CIP	Attach3_RecruitLetters_CIP.docx	12/03/2012
Fast-Track_Request_Usability_Test_CIP	Fast-Track_Request_Usability_Test_CIP.doc	12/05/2012

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