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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.