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Federal forms, ICRs, and supporting documents

Information Collection

Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival

IC 226499 under ICR 201502-0920-001 · OMB 0920-0572.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Screener Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival Form and Instruction
Informed Consent and Rescreening Form Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival Form and Instruction
Focus Group Discussion Guide for African American Women Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival Form and Instruction
Focus Group Discussion Guide for Hispanic Women Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival Form and Instruction
Focus Group Discussion Guide for African American Men Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival Form and Instruction
Focus Group Discussion Guide for Hispanic Men Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival Form and Instruction
Digital Ad Response Sheet (completed during focus groups with men) Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival Form and Instruction
Screener
ATTACHMENT A1 Screener_04 24 17.docx 		Form and Instruction
Informed Consent and Rescreening Form
ATTACHMENT A2 Rescreener and Consent form_04 24 17_0248pm.docx 		Form and Instruction
Focus Group Discussion Guide for African American Women
ATTACHMENT B1 FG Guide African American Women 04 24 17.docx 		Form and Instruction
Focus Group Discussion Guide for Hispanic Women
ATTACHMENT B2 FG Guide Hispanic Women 04 24 17.docx 		Form and Instruction
Focus Group Discussion Guide for African American Men
ATTACHMENT B3 FG Guide African American Male 04 24 17.docx 		Form and Instruction
Focus Group Discussion Guide for Hispanic Men
ATTACHMENT B4 FG Guide Hispanic Men 04 24 17.docx 		Form and Instruction
Digital Ad Response Sheet (completed during focus groups
ATTACHMENT B5 Digital Ad Response Sheet _ 04 25_17.docx 		Form and Instruction
ATTACHMENT C Materials for testing_04 24 17.docx
Materials for Testing		IC Document
HMTS_Expedited_Review_Form_nbl_Revised_4_26_17_5pm.docx
HMTS Review Form for Focus Group Testing of Skin Cancer Messages		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 N/A No   Paper Only
Form and Instruction N/A No   Paper Only
Form and Instruction N/A No   Paper Only
Form and Instruction N/A No   Paper Only
Form and Instruction N/A No   Paper Only
Form and Instruction N/A No   Paper Only
Form and Instruction N/A No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 756 0 756 0 0 0
Annual IC Time Burden (Hours) 398 0 398 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Materials for Testing 04/24/2017
HMTS Review Form for Focus Group Testing of Skin Cancer Messages 04/25/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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