Information Collection

Focus Group Testing to Effectively Plan and Tailor a Young Women and Breast Cancer Communication Campaign

IC 235525 under ICR 201808-0920-001 · OMB 0920-0800.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0800 can be found here:

2022-02-11 - Reinstatement with change of a previously approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0800 Focus Group Testing to Effectively Plan and Tailor a Young Women and Breast Cancer Communication Campaign	Form and Instruction
0920-0800 Discussion Guide for Hispanic (family history) Eng Attachment B1. Discussion Guide for Hispanic (Family History)_English 2-4-19.docx	Form and Instruction
0920-0800 Discussion Guide for Hispanic (family history) Spa Attachment B2. Discussion Guide for Hispanic (Family History)_Spanish 3-14-19.docx	Form and Instruction
0920-0800 Discussion Guide for Hispanic (no fam hist) Eng Attachment B3. Discussion Guide for Hispanic (No Family History)_English 2-4-19.docx	Form and Instruction
0920-0800 Discussion Guide for Hispanic (no fam hist) Spa Attachment B4. Discussion Guide for Hispanic (No Family History)_Spanish 3-14-19.docx	Form and Instruction
0920-0800 Discussion Guide for AA (family history) Attachment C1. Discussion Guide for AA (With Family History) 2-4-19.docx	Form and Instruction
0920-0800 Discussion Guide for AA (no fam hist) Attachment C2. Discussion Guide for AA (Without Family History) 2-4-19.docx	Form and Instruction
0920-0800 Discussion Guide for AIAN (family history) Attachment D1. Discussion Guide for AIAN (Family History) 2-4-19.docx	Form and Instruction
0920-0800 Discussion Guide for AIAN (no fam hist) Attachment D2. Discussion Guide for AIAN (No Family History) 2-4-19.docx	Form and Instruction
0920-0800 Screening Instrument Hispanic Eng Attachment E1. Screening Instrument for Hispanic Young Women_English 2-4-19.docx	Form and Instruction
0920-0800 Screening Instrument Hispanic Spa Attachment E2. Screening Instrument for Hispanic Young Women_Spanish 3-14-19.docx	Form and Instruction
0920-0800 Screening Instrument AA Attachment F. Screening Instrument for African American Young Women 2-4-19.docx	Form and Instruction
0920-0800 Screening Instrument AIAN Attachment G. Screening Instrument for AIAN Young Women 2-4-19.docx	Form and Instruction
Attachment A. Legislative Authority - EARLY Act Reauthorization.pdf Legislative Authority	IC Document
Attachment B5. Materials for Testing_Hispanic Young Women_English.pdf Materials for Testing Hispanic Eng	IC Document
Attachment B6. Materials for Testing_Hispanic Young Women_Spanish.pdf Materials for Testing Hispanic Spa	IC Document
Attachment C3. Materials for Testing_AA Young Women 2-4-19.pdf Materials for Testing AA	IC Document
Attachment D3. Materials for Testing_AIAN Young Women.pdf Materials for Testing AIAN	IC Document
Attachment H1. Participant Information Sheet_English.docx Participant Information Sheet Eng	IC Document
Attachment H2. Participant Information Sheet_Spanish.docx Participant Information Sheet Spa	IC Document
Supporting Statement Part A_v5 3-15-19 final.doc SSA	IC Document
Supporting Statement Part B_v5 3-15-19.docx SSB	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Focus Group Testing to Effectively Plan and Tailor a Young Women and Breast Cancer Communication Campaign

Agency IC Tracking Number:

0920-0800-19AJF

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	0920-0800	Discussion Guide for Hispanic (family history) Eng	Attachment B1. Discussion Guide for Hispanic (Family History)_English 2-4-19.docx	No	Fillable Fileable
Form and Instruction	0920-0800	Discussion Guide for Hispanic (family history) Spa	Attachment B2. Discussion Guide for Hispanic (Family History)_Spanish 3-14-19.docx	No	Fillable Fileable
Form and Instruction	0920-0800	Discussion Guide for Hispanic (no fam hist) Eng	Attachment B3. Discussion Guide for Hispanic (No Family History)_English 2-4-19.docx	No	Fillable Fileable
Form and Instruction	0920-0800	Discussion Guide for Hispanic (no fam hist) Spa	Attachment B4. Discussion Guide for Hispanic (No Family History)_Spanish 3-14-19.docx	No	Fillable Fileable
Form and Instruction	0920-0800	Discussion Guide for AA (family history)	Attachment C1. Discussion Guide for AA (With Family History) 2-4-19.docx	No	Fillable Fileable
Form and Instruction	0920-0800	Discussion Guide for AA (no fam hist)	Attachment C2. Discussion Guide for AA (Without Family History) 2-4-19.docx	No	Fillable Fileable
Form and Instruction	0920-0800	Discussion Guide for AIAN (family history)	Attachment D1. Discussion Guide for AIAN (Family History) 2-4-19.docx	No	Fillable Fileable
Form and Instruction	0920-0800	Discussion Guide for AIAN (no fam hist)	Attachment D2. Discussion Guide for AIAN (No Family History) 2-4-19.docx	No	Fillable Fileable
Form and Instruction	0920-0800	Screening Instrument Hispanic Eng	Attachment E1. Screening Instrument for Hispanic Young Women_English 2-4-19.docx	No	Fillable Fileable
Form and Instruction	0920-0800	Screening Instrument Hispanic Spa	Attachment E2. Screening Instrument for Hispanic Young Women_Spanish 3-14-19.docx	No	Fillable Fileable
Form and Instruction	0920-0800	Screening Instrument AA	Attachment F. Screening Instrument for African American Young Women 2-4-19.docx	No	Fillable Fileable
Form and Instruction	0920-0800	Screening Instrument AIAN	Attachment G. Screening Instrument for AIAN Young Women 2-4-19.docx	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 594

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	594	594
Annual IC Time Burden (Hours)	317	317
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Legislative Authority	Attachment A. Legislative Authority - EARLY Act Reauthorization.pdf	03/29/2019
Materials for Testing Hispanic Eng	Attachment B5. Materials for Testing_Hispanic Young Women_English.pdf	03/29/2019
Materials for Testing Hispanic Spa	Attachment B6. Materials for Testing_Hispanic Young Women_Spanish.pdf	03/29/2019
Materials for Testing AA	Attachment C3. Materials for Testing_AA Young Women 2-4-19.pdf	03/29/2019
Materials for Testing AIAN	Attachment D3. Materials for Testing_AIAN Young Women.pdf	03/29/2019
Participant Information Sheet Eng	Attachment H1. Participant Information Sheet_English.docx	03/29/2019
Participant Information Sheet Spa	Attachment H2. Participant Information Sheet_Spanish.docx	03/29/2019
SSA	Supporting Statement Part A_v5 3-15-19 final.doc	03/29/2019
SSB	Supporting Statement Part B_v5 3-15-19.docx	03/29/2019

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