Information Collection

Att 3b_Web-based Questionnaire

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

Documents and Forms

Document Name Document Type
Form 0920- 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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att 3b_Web-based Questionnaire	Agency IC Tracking Number:	0920-19BHM

Is this a Common Form? No		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
Form and Instruction	0920-	Ovarian Cancer Survivorship Survey	OCS Att 3b web-based questionnaire Final.pdf		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 %

	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

Title	Document	Date Uploaded
Att 5a_Web-based Ads for Social Media Recruitment	OCS Att 5a Web-based Ads for Social Media Recruitment Final.docx	06/15/2020
Att 5b_ Web-based FAQ	OCS Att 5b web-based FAQ Final.pdf	06/15/2020

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