ABC Screener (Attachment 2)

Awareness and Beliefs About Cancer (ABC) Survey

Documents and Forms

Document Name Document Type
Form 1 ABC Screener (Attachment 2) Form and Instruction
1 ABC Screener Attach2_ABC Screener_2-11-2014.docx Form and Instruction

Information Collection (IC) Details

IC Title:	ABC Screener (Attachment 2)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	ABC Screener	Attach2_ABC Screener_2-11-2014.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Clinical, Basic and Population-based Research Studies of hte National Institutes of Health (NIH)	FR Citation: 67 FR 60776

Number of Respondents: 14,000	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	Previously Approved
Annual Number of Responses for this IC	14,000	6,000	8,000
Annual IC Time Burden (Hours)	1,167	500	667
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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