Information Collection

Focus Groups Assessing the Uptake and Effectiveness of Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign Materials

IC 219428 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Focus Groups Assessing the Uptake and Effectiveness of Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign Materials Form and Instruction
C_Focus Group Guide_121815.docx Instruction
Recruitment Form - Hispanic D1_Recruitment Form His.doc Form and Instruction
Recruitment Form -Low SES D2_Recruitment Form lowSES.doc Form and Instruction
Recruitment Form - Disabilities D3_Recruitment Form disabilities.doc Form and Instruction
SSA_IK GenIC_122215.doc Supporting Statement A IC Document
SSB_IK GenIC_122215.doc Supporting Statement B IC Document
App B_Consent.doc Consent Form IC Document
E1_cervical_facts.pdf Inside Knowledge - Cervical Cancer Facts IC Document
E2_uterine_facts.pdf Inside Knowledge - Uterine Cancer Facts IC Document
E3_ovarian_facts.pdf Inside Knowledge - Ovarian Cancer Facts IC Document
E4_vagvulv_facts.pdf Inside Knowledge - Vaginal and Vulvar Cancer Facts IC Document
App A1_PHSA.docx PHSA IC Document
App A2_Johannas Law.pdf Johanna's Law IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Focus Groups Assessing the Uptake and Effectiveness of Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign Materials	Agency IC Tracking Number:	16HS

IC Status: New

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	NA	Recruitment Form - Hispanic	D1_Recruitment Form His.doc	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Recruitment Form -Low SES	D2_Recruitment Form lowSES.doc	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Recruitment Form - Disabilities	D3_Recruitment Form disabilities.doc	NA	Yes	Yes	Fillable Fileable
Instruction			C_Focus Group Guide_121815.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 582	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 5 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	582	582
Annual IC Time Burden (Hours)	402	402
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	SSA_IK GenIC_122215.doc	12/29/2015
Supporting Statement B	SSB_IK GenIC_122215.doc	12/29/2015
Consent Form	App B_Consent.doc	12/29/2015
Inside Knowledge - Cervical Cancer Facts	E1_cervical_facts.pdf	12/29/2015
Inside Knowledge - Uterine Cancer Facts	E2_uterine_facts.pdf	12/29/2015
Inside Knowledge - Ovarian Cancer Facts	E3_ovarian_facts.pdf	12/29/2015
Inside Knowledge - Vaginal and Vulvar Cancer Facts	E4_vagvulv_facts.pdf	12/29/2015
PHSA	App A1_PHSA.docx	12/29/2015
Johanna's Law	App A2_Johannas Law.pdf	12/29/2015

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