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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.