Sub-study #27_Satisfaction with Cancer Research Programs in Underserved Communities (CGH)

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⚠️ Notice: This information collection may be referencing outdated material.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 #27_Satisfaction with Cancer Research Programs in Underserved Communities (CGH) Form and Instruction
1 Facilitator Conducted Survey Attach1_CGH_Survey_5-3-2013.doc Form and Instruction
Fast-Track Request_#27_CGH_5-6-2013.docx Fast-Track Request_#27_CGH_5-6-2013 IC Document

Information Collection (IC) Details

IC Title:	Sub-study #27_Satisfaction with Cancer Research Programs in Underserved Communities (CGH)	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	Facilitator Conducted Survey	Attach1_CGH_Survey_5-3-2013.doc		No	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	150	0	0	0	0	0
Annual IC Time Burden (Hours)	50	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Fast-Track Request_#27_CGH_5-6-2013	Fast-Track Request_#27_CGH_5-6-2013.docx	05/06/2013

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