Formative Assessment of the Information Needs to Prevent Skin Cancer Among Spanish speaking Outdoor Workers

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Document Name Document Type
Focus Group Guide - English_Spanish 10-29-19.docx Other-Focus Group Guide
GenICRequest_Focus groups_Skin_Cancer_110619.docx Request for Approval IC Document
Statement A_110519 Clean.docx Supporting Statement A IC Document
Statement B_110419Clean.docx Supporting Statement B IC Document
Recruitment_Consent_Form_English_Spanish 102919.docx Consent IC Document
Att II. DSI IRB_Nonresearch_Flynn_Skin Cancer Outdoor Workers_2019 Aug 30.pdf Research Determination IC Document
Att I. OSH Act.doc Authorizing legislation IC Document

Information Collection (IC) Details

IC Title:	Formative Assessment of the Information Needs to Prevent Skin Cancer Among Spanish speaking Outdoor Workers	Agency IC Tracking Number:	0920-1154-20BF

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
Other-Focus Group Guide			Focus Group Guide - English_Spanish 10-29-19.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	28	28
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	GenICRequest_Focus groups_Skin_Cancer_110619.docx	11/06/2019
Supporting Statement A	Statement A_110519 Clean.docx	11/06/2019
Supporting Statement B	Statement B_110419Clean.docx	11/06/2019
Consent	Recruitment_Consent_Form_English_Spanish 102919.docx	11/06/2019
Research Determination	Att II. DSI IRB_Nonresearch_Flynn_Skin Cancer Outdoor Workers_2019 Aug 30.pdf	11/06/2019
Authorizing legislation	Att I. OSH Act.doc	11/06/2019

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