Sub-study #4_REVISED Smokefree Women Customer Satisfaction Study

Formative Research, Pretesting, and Customer Satisfaction of NCI's Communication and Education Resources (NCI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0046 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Sub-study #4_REVISED Smokefree Women Customer Satisfaction Study Form and Instruction
1 Consent AttachA_Consent_REV_03102014.doc Form and Instruction
2 Screener AttachC_Screener-Survey_REV_03102014.docx Form and Instruction
3 Initial Survey AttachD_Initial-Survey_REV_03102014.docx Form and Instruction
4 Final Survey AttachE_Customer-Satis-Survey_REV_03102014.docx Form and Instruction
ASPE Comments_NCI-Response.docx ASPE Comments_NCI-Response IC Document
SFW-Study_Gen-Sub-Study-Form_01172014.doc SFW-Study_Gen-Sub-Study-Form_01172014 IC Document
SFW-Study_Mini-SSB_03102014.doc SFW-Study_Mini-SSB_03102014 IC Document
AttachB_Study-Emails_03102014.doc AttachB_Study-Emails_03102014 IC Document
AttachF_OHSR_Exemption.pdf AttachF_OHSR_Exemption IC Document
SFW-Study_Mini-SSA_03102014.doc SFW-Study_Mini-SSA_03102014 IC Document

Information Collection (IC) Details

IC Title:	Sub-study #4_REVISED Smokefree Women Customer Satisfaction Study	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Consent	AttachA_Consent_REV_03102014.doc	Yes	Yes	Fillable Fileable
Form and Instruction	2	Screener	AttachC_Screener-Survey_REV_03102014.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Initial Survey	AttachD_Initial-Survey_REV_03102014.docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	Final Survey	AttachE_Customer-Satis-Survey_REV_03102014.docx	Yes	Yes	Fillable Fileable

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: 400	Number of Respondents for Small Entity: 0

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	1,200	0	0	0	0	0
Annual IC Time Burden (Hours)	262	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
ASPE Comments_NCI-Response	ASPE Comments_NCI-Response.docx	03/11/2014
SFW-Study_Gen-Sub-Study-Form_01172014	SFW-Study_Gen-Sub-Study-Form_01172014.doc	03/11/2014
SFW-Study_Mini-SSB_03102014	SFW-Study_Mini-SSB_03102014.doc	03/11/2014
AttachB_Study-Emails_03102014	AttachB_Study-Emails_03102014.doc	03/11/2014
AttachF_OHSR_Exemption	AttachF_OHSR_Exemption.pdf	03/11/2014
SFW-Study_Mini-SSA_03102014	SFW-Study_Mini-SSA_03102014.doc	03/11/2014

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