Self-affirmation and affect

A Generic Submission for Theory Development and Validation (NCI)

Documents and Forms

Document Name Document Type
Form 1 Self-affirmation and affect Form and Instruction
1 Survey Screenshots Attachment A Survey ScreenShots.doc Form and Instruction
0925-0645 Generic Clearance Form 12 9 2014.docx Generic Clearance Form Self-affirmation and affect IC Document
0925-0645 Justification Memo 12 9 2014.docx Sub-Study Memo Self-affirmation and affect IC Document
Attachment B Questionaire Word Format.docx Survey- Word Version IC Document
Attachment C Readings.doc Readings IC Document
Attachment D IRB Approval.pdf IRB Approval Letter IC Document

Information Collection (IC) Details

IC Title:	Self-affirmation and affect	Agency IC Tracking Number:

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	1	Survey Screenshots	Attachment A Survey ScreenShots.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 640	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	640	640
Annual IC Time Burden (Hours)	320	320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Clearance Form Self-affirmation and affect	0925-0645 Generic Clearance Form 12 9 2014.docx	01/22/2015
Sub-Study Memo Self-affirmation and affect	0925-0645 Justification Memo 12 9 2014.docx	01/22/2015
Survey- Word Version	Attachment B Questionaire Word Format.docx	01/22/2015
Readings	Attachment C Readings.doc	01/22/2015
IRB Approval Letter	Attachment D IRB Approval.pdf	01/22/2015

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