Information Collection

genIC Cancer Survivorship Needs Assessment for NCCCProgram Grantees

IC 223011 under ICR 201412-0920-011 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A_Cancer Survivorship Needs Assessment Instrument_Word Version.docx	Other-WORD
Attachment B_Cancer Survivorship Needs Assessment Instrument_Web Version.docx	Other-Web Version
Attachment C_Telephone Focus Group Interview Guide_Health Care Professional Audience.docx	Other-WORD
Attachment D_Telephone Focus Group Interview Guide_Cancer Survivor and Caregiver Audience.docx	Other-WORD
Attachment E_Telephone Focus Group Interview Guide_Policy and Advocacy Audience.docx	Other-WORD
NCCCP-EVAL-SSA.docx SupSta A	IC Document
NCCCP-EVAL-SSB.docx SupSta B	IC Document
Attachment F_Web-based Assessment Advanced Notification Email.docx Att F_Advanced Email to NCCP Program Directors	IC Document
Attachment G_Web-based Assessment Invitation Email.docx Att G_NCCP Grantee Invitation Email	IC Document
Attachment H_Web-based Assessment Reminder Email.docx Att H_Reminder Email _ NCCCP Grantee	IC Document
Attachment I_Web-based Assessment Reminder Phone Script.docx Att I_Reminder Phone Script	IC Document
Attachment J_Telephone Focus Group Recruitment Email.docx Att J_Telphone Focus Group Recruitment Email	IC Document
Attachment K_Telephone Focus Group Confirmation Email.docx Att K_ Telephone Focus Group Confirmation Email	IC Document

IC Title:

genIC Cancer Survivorship Needs Assessment for NCCCProgram Grantees

Agency IC Tracking Number:

16BAE

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD	Attachment A_Cancer Survivorship Needs Assessment Instrument_Word Version.docx	Yes	Yes	Paper Only
Other-Web Version	Attachment B_Cancer Survivorship Needs Assessment Instrument_Web Version.docx	Yes	Yes	Fillable Printable
Other-WORD	Attachment C_Telephone Focus Group Interview Guide_Health Care Professional Audience.docx	No		Paper Only
Other-WORD	Attachment D_Telephone Focus Group Interview Guide_Cancer Survivor and Caregiver Audience.docx	No		Paper Only
Other-WORD	Attachment E_Telephone Focus Group Interview Guide_Policy and Advocacy Audience.docx	No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 65

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	65	65
Annual IC Time Burden (Hours)	87	87
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SupSta A	NCCCP-EVAL-SSA.docx	08/15/2016
SupSta B	NCCCP-EVAL-SSB.docx	08/15/2016
Att F_Advanced Email to NCCP Program Directors	Attachment F_Web-based Assessment Advanced Notification Email.docx	08/15/2016
Att G_NCCP Grantee Invitation Email	Attachment G_Web-based Assessment Invitation Email.docx	08/15/2016
Att H_Reminder Email _ NCCCP Grantee	Attachment H_Web-based Assessment Reminder Email.docx	08/15/2016
Att I_Reminder Phone Script	Attachment I_Web-based Assessment Reminder Phone Script.docx	08/15/2016
Att J_Telphone Focus Group Recruitment Email	Attachment J_Telephone Focus Group Recruitment Email.docx	08/15/2016
Att K_ Telephone Focus Group Confirmation Email	Attachment K_Telephone Focus Group Confirmation Email.docx	08/15/2016

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