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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Focus Group for Insider Knowledge:Get the Facts about Gynecologic Cancer
Agency IC Tracking Number:
IC Status:
Unchanged
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
none
Recruitment screener
C1-1 GYN Consumer Screener 4 17 09.doc
No
No
Paper Only
Form
2
Final Consumer Screener
C1-1_GYN_Consumer_Screener_05_12_09.doc
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
432
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
432
0
0
0
0
432
Annual IC Time Burden (Hours)
346
0
0
0
0
346
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Focus Group Guide
C1-2 GYN Consumer Mod Guide 4 17 09.doc
04/23/2009
Consent form
C1-3 Participant Consent Form 4 17 09.doc
04/23/2009
Final Focus Group Guide
C1-2_GYN_Mod_Guide_05_11_09.doc
05/26/2009
Terms of Clearance
Terms of Clearance.pdf
05/26/2009
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.