genIC Cancer Survivorship Needs Assessment for NCCCProgram Grantees

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.