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

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

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:

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

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 %

	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

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.