Information Collection

Tailoring Gynecologic Cancer Education for Health Care Providers

IC 211260 under ICR 201111-0920-004 · OMB 0920-0800.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0800 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
App A Focus Group Guide Grp A 3 28 14 final.docx	Other-Word
App B Focus Group Guide HCP Grp B 3 28 14 final.docx	Other-word
App C recruitment form hcp 3 28 2014.doc	Other-word
SS A_3 28 2014.docx Supporting Statement A	IC Document
SS B_3 28 2014.docx Supporting Statement B	IC Document
App D Consent Form 3 28 14 final.doc Participant Consent Form	IC Document
NCCDPHP 684 Form No IRB required.pdf IRB Determination	IC Document

IC Title:

Tailoring Gynecologic Cancer Education for Health Care Providers

Agency IC Tracking Number:

0920-14SC

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Word	App A Focus Group Guide Grp A 3 28 14 final.docx	No	Fillable Printable
Other-word	App B Focus Group Guide HCP Grp B 3 28 14 final.docx	No	Fillable Printable
Other-word	App C recruitment form hcp 3 28 2014.doc	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 130

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	130	130
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	SS A_3 28 2014.docx	04/14/2014
Supporting Statement B	SS B_3 28 2014.docx	04/14/2014
Participant Consent Form	App D Consent Form 3 28 14 final.doc	04/14/2014
IRB Determination	NCCDPHP 684 Form No IRB required.pdf	04/14/2014

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