Information Collection

Att 3b_Web-based Questionnaire

IC 242243 under ICR 202006-0920-008 · OMB 0920-1314.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- Ovarian Cancer Survivorship Survey Att 3b_Web-based Questionnaire	Form and Instruction
0920- Ovarian Cancer Survivorship Survey OCS Att 3b web-based questionnaire Final.pdf	Form and Instruction
OCS Att 5a Web-based Ads for Social Media Recruitment Final.docx Att 5a_Web-based Ads for Social Media Recruitment	IC Document
OCS Att 5b web-based FAQ Final.pdf Att 5b_ Web-based FAQ	IC Document

IC Title:

Agency IC Tracking Number:

0920-19BHM

Is this a Common Form? No

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 195

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	195	195
Annual IC Time Burden (Hours)	163	163
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 5a_Web-based Ads for Social Media Recruitment		06/15/2020
Att 5b_ Web-based FAQ		06/15/2020

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

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