Att 3b_ Web-Based Screener & Informed Consent

Understanding the Needs of Ovarian Cancer Survivors

Documents and Forms

Document Name Document Type
Form 0920- Att 3b_ Web-Based Screener & Informed Consent Form and Instruction
0920- Ovarian Cancer Survivorship Survey Screener OCS Att 3b web-based questionnaire Final.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Att 3b_ Web-Based Screener & Informed Consent	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 Screener	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: 105	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	105	105
Annual IC Time Burden (Hours)	88	88
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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