Pre-exposure Survey

[NCCDPHP] Evaluation of a Prostate Cancer Decision Aid

Documents and Forms

Document Name Document Type
Form 0920-24CB Pre-exposure Survey Form
Form 0920-24CB Pre-exposure Survey Form
0920-24CB Pre-Exposure Survey_Online_English Attachment 06f_Pre-Exposure Survey_Online_English.docx Form
0920-24CB Pre-Exposure Survey_Online_English Attachment 06f_Pre-Exposure Survey_Online_English.docx Form
0920-24CB Pre-Exposure Survey_Online_Spanish Attachment 06g_Pre-Exposure Survey_Online_Spanish.docx Form
0920-24CB Pre-Exposure Survey_Online_Spanish Attachment 06g_Pre-Exposure Survey_Online_Spanish.docx Form

Information Collection (IC) Details

IC Title:	Pre-exposure Survey	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	Pre-Exposure Survey_Online_English	Attachment 06f_Pre-Exposure Survey_Online_English.docx		Yes	Yes	Fillable Fileable
Form	0920-24CB	Pre-Exposure Survey_Online_Spanish	Attachment 06g_Pre-Exposure Survey_Online_Spanish.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	300	300
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.