Att 3c_Web-based Screener (ONLY)

Understanding the Needs of Ovarian Cancer Survivors

Documents and Forms

Document Name Document Type
Form 0920- Att 3c_Web-based Screener (ONLY) Form
0920- Web-based Screener (Ovarian Cancer Survivorship Survey) OCS Att 3c web-based screener & informed consent Final.pdf Form

Information Collection (IC) Details

IC Title:	Att 3c_Web-based Screener (ONLY)	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	0920-	Web-based Screener (Ovarian Cancer Survivorship Survey)	OCS Att 3c web-based screener & informed consent Final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	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	100	100
Annual IC Time Burden (Hours)	3	3
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.