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User Experience Interview
[NCCDPHP] Evaluation of a Prostate Cancer Decision Aid
OMB: 0920-1438
IC ID: 269803
OMB.report
HHS/CDC
OMB 0920-1438
ICR 202407-0920-009
IC 269803
( )
Documents and Forms
Document Name
Document Type
Form 0920-24CB
User Experience Interview
Form
Form 0920-24CB
User Experience Interview
Form
0920-24CB User Experience Interviews_Interview Guide_English
Attachment 09e_User Experience Interviews_Interview Guide_English.docx
Form
0920-24CB User Experience Interviews_Interview Guide_English
Attachment 09e_User Experience Interviews_Interview Guide_English.docx
Form
0920-24CB User Experience Interviews_Interview Guide_Spanish
Attachment 09f_User Experience Interviews_Interview Guide_Spanish.docx
Form
0920-24CB User Experience Interviews_Interview Guide_Spanish
Attachment 09f_User Experience Interviews_Interview Guide_Spanish.docx
Form
Attachment 09a_User Experience Interviews_Recruitment Email_English.docx
User Experience Interviews_Recruitment Email_English
IC Document
Attachment 09a_User Experience Interviews_Recruitment Email_English.docx
User Experience Interviews_Recruitment Email_English
IC Document
Attachment 09b_User Experience Interviews_Recruitment Email_Spanish.docx
User Experience Interviews_Recruitment Email_Spanish
IC Document
Attachment 09b_User Experience Interviews_Recruitment Email_Spanish.docx
User Experience Interviews_Recruitment Email_Spanish
IC Document
Attachment 09c_User Experience Interviews_Consent Statement_English.docx
User Experience Interviews_Consent Statement_English
IC Document
Attachment 09c_User Experience Interviews_Consent Statement_English.docx
User Experience Interviews_Consent Statement_English
IC Document
Attachment 09d_User Experience Interviews_Consent Statement_Spanish.docx
User Experience Interviews_Consent Statement_Spanish
IC Document
Attachment 09d_User Experience Interviews_Consent Statement_Spanish.docx
User Experience Interviews_Consent Statement_Spanish
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
User Experience Interview
Agency IC Tracking Number:
0920-24CB
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
0920-24CB
User Experience Interviews_Interview Guide_English
Attachment 09e_User Experience Interviews_Interview Guide_English.docx
Yes
Yes
Fillable Fileable
Form
0920-24CB
User Experience Interviews_Interview Guide_Spanish
Attachment 09f_User Experience Interviews_Interview Guide_Spanish.docx
Yes
Yes
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:
30
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
30
0
30
0
0
0
Annual IC Time Burden (Hours)
10
0
10
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
User Experience Interviews_Recruitment Email_English
Attachment 09a_User Experience Interviews_Recruitment Email_English.docx
08/02/2024
User Experience Interviews_Recruitment Email_Spanish
Attachment 09b_User Experience Interviews_Recruitment Email_Spanish.docx
08/02/2024
User Experience Interviews_Consent Statement_English
Attachment 09c_User Experience Interviews_Consent Statement_English.docx
08/02/2024
User Experience Interviews_Consent Statement_Spanish
Attachment 09d_User Experience Interviews_Consent Statement_Spanish.docx
08/02/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.