Information Collection

Assessing the Uptake and Effectiveness of Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign (14AFG)

IC 211763 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⚠️ Notice: This information collection may be referencing outdated material.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
Assessing the Uptake and Effectiveness of Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign (14AFG)	Form
Recruitment App D_Recruitment Form_5 21 2014.doc	Form
Focus Group Guide App C_Focus Group Guide_5 23 2014.docx	Form
SSA_5 23 2014.doc Supporting Statement Part A	IC Document
SSB_5 23 2014.doc Supporting Statement Part B	IC Document
App B_Consent_5 21 2014.doc Consent Form	IC Document
App A1_PHSA.DOCX Authorizing Legislation Part 1	IC Document
App A2_Johannas Law.pdf Authorizing Legislation Part 2	IC Document
IRB IK_NCCCP_684.pdf IRB	IC Document

IC Title:

Assessing the Uptake and Effectiveness of Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign (14AFG)

Agency IC Tracking Number:

14AFG

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 247b-17 42 CFR 241 (To search for a specific CFR, visit the Code of Federal Regulations.)

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	none	Recruitment	App D_Recruitment Form_5 21 2014.doc		No		Paper Only
Form	none	Focus Group Guide	App C_Focus Group Guide_5 23 2014.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,800

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	1,800	1,800
Annual IC Time Burden (Hours)	1,240	1,240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Part A	SSA_5 23 2014.doc	06/02/2014
Supporting Statement Part B	SSB_5 23 2014.doc	06/02/2014
Consent Form	App B_Consent_5 21 2014.doc	06/02/2014
Authorizing Legislation Part 1	App A1_PHSA.DOCX	06/02/2014
Authorizing Legislation Part 2	App A2_Johannas Law.pdf	06/02/2014
IRB	IRB IK_NCCCP_684.pdf	06/02/2014

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