Information Collection

Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer

IC 216348 under ICR 201408-0920-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0800 Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Form and Instruction
G1 - Discussion Guide for Other (No Family History)_04 09 2015.docx	Instruction
K - Participant Information Sheets_final.docx	Instruction
0920-0800 B2 - Materials for Testing_AJ (Family History)_4 09 2015 B2 - Materials for Testing_AJ (Family History)_4 09 2015.pdf	Form and Instruction
0920-0800 C1 - Discussion Guide for AJ (No Family History)_04 09 2 C1 - Discussion Guide for AJ (No Family History)_04 09 2015.docx	Form and Instruction
0920-0800 C2 - Materials for Testing_AJ (No Family History)_4 09 2 C2 - Materials for Testing_AJ (No Family History)_4 09 2015.pdf	Form and Instruction
0920-0800 D1 - Discussion Guide for AA (Family History)_04 09 2015 D1 - Discussion Guide for AA (Family History)_04 09 2015.docx	Form and Instruction
0920-0800 D2 - Materials for Testing_AA (Family History)_4 09 2015 D2 - Materials for Testing_AA (Family History)_4 09 2015.pdf	Form and Instruction
0920-0800 E1 - Discussion Guide for AA (No Family History)_04 09 2 E1 - Discussion Guide for AA (No Family History)_04 09 2015.docx	Form and Instruction
0920-0800 F1 - Discussion Guide Other (Family History)_04 09 2015 F1 - Discussion Guide Other (Family History)_04 09 2015.docx	Form and Instruction
0920-0800 F2 - Materials for Testing_Other (Family History)_4 09 2 F2 - Materials for Testing_Other (Family History)_4 09 2015.pdf	Form and Instruction
0920-0800 H - Screening Instrument for Ashkenazi Jewish Young Wome H - Screening Instrument for Ashkenazi Jewish Young Women.docx	Form and Instruction
0920-0800 I - Screening Instrument for African American Young Wome I - Screening Instrument for African American Young Women.docx	Form and Instruction
0920-0800 J - Screening Instrument for Other Young Women J - Screening Instrument for Other Young Women.docx	Form and Instruction
SS A v10_4 27 2015.doc SS A v10_4 27 2015	IC Document
SS B v10_4 27 2015.doc SS B v10_4 27 2015	IC Document
A Legislative Authority_Early Act Reauthorization.pdf A Legislative Authority_Early Act Reauthorization	IC Document
Form 684.pdf Form 684	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer

Agency IC Tracking Number:

15ACO

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	0920-0800	F2 - Materials for Testing_Other (Family History)_4 09 2015	F2 - Materials for Testing_Other (Family History)_4 09 2015.pdf	No	Fillable Printable
Instruction			G1 - Discussion Guide for Other (No Family History)_04 09 2015.docx	No	Fillable Printable
Form and Instruction	0920-0800	H - Screening Instrument for Ashkenazi Jewish Young Women	H - Screening Instrument for Ashkenazi Jewish Young Women.docx	No	Fillable Printable
Form and Instruction	0920-0800	I - Screening Instrument for African American Young Women	I - Screening Instrument for African American Young Women.docx	No	Fillable Printable
Form and Instruction	0920-0800	J - Screening Instrument for Other Young Women	J - Screening Instrument for Other Young Women.docx	No	Fillable Printable
Instruction			K - Participant Information Sheets_final.docx	No	Fillable Printable
Form and Instruction	0920-0800	B2 - Materials for Testing_AJ (Family History)_4 09 2015	B2 - Materials for Testing_AJ (Family History)_4 09 2015.pdf	No	Fillable Printable
Form and Instruction	0920-0800	C1 - Discussion Guide for AJ (No Family History)_04 09 2015	C1 - Discussion Guide for AJ (No Family History)_04 09 2015.docx	No	Fillable Printable
Form and Instruction	0920-0800	C2 - Materials for Testing_AJ (No Family History)_4 09 2015	C2 - Materials for Testing_AJ (No Family History)_4 09 2015.pdf	No	Fillable Printable
Form and Instruction	0920-0800	D1 - Discussion Guide for AA (Family History)_04 09 2015	D1 - Discussion Guide for AA (Family History)_04 09 2015.docx	No	Fillable Printable
Form and Instruction	0920-0800	D2 - Materials for Testing_AA (Family History)_4 09 2015	D2 - Materials for Testing_AA (Family History)_4 09 2015.pdf	No	Fillable Printable
Form and Instruction	0920-0800	E1 - Discussion Guide for AA (No Family History)_04 09 2015	E1 - Discussion Guide for AA (No Family History)_04 09 2015.docx	No	Fillable Printable
Form and Instruction	0920-0800	F1 - Discussion Guide Other (Family History)_04 09 2015	F1 - Discussion Guide Other (Family History)_04 09 2015.docx	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 540

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	540	540
Annual IC Time Burden (Hours)	378	378
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SS A v10_4 27 2015	SS A v10_4 27 2015.doc	04/30/2015
SS B v10_4 27 2015	SS B v10_4 27 2015.doc	04/30/2015
A Legislative Authority_Early Act Reauthorization	A Legislative Authority_Early Act Reauthorization.pdf	04/30/2015
Form 684	Form 684.pdf	04/30/2015

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