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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer
Agency IC Tracking Number:
15ACO
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
0920-0800
B2 - Materials for Testing_AJ (Family History)_4 09 2015
B2 - Materials for Testing_AJ (Family History)_4 09 2015.pdf
No
Fillable Printable
Form and Instruction
0920-0800
C1 - Discussion Guide for AJ (No Family History)_04 09 2015
C1 - Discussion Guide for AJ (No Family History)_04 09 2015.docx
No
Fillable Printable
Form and Instruction
0920-0800
C2 - Materials for Testing_AJ (No Family History)_4 09 2015
C2 - Materials for Testing_AJ (No Family History)_4 09 2015.pdf
No
Fillable Printable
Form and Instruction
0920-0800
D1 - Discussion Guide for AA (Family History)_04 09 2015
D1 - Discussion Guide for AA (Family History)_04 09 2015.docx
No
Fillable Printable
Form and Instruction
0920-0800
D2 - Materials for Testing_AA (Family History)_4 09 2015
D2 - Materials for Testing_AA (Family History)_4 09 2015.pdf
No
Fillable Printable
Form and Instruction
0920-0800
E1 - Discussion Guide for AA (No Family History)_04 09 2015
E1 - Discussion Guide for AA (No Family History)_04 09 2015.docx
No
Fillable Printable
Form and Instruction
0920-0800
F1 - Discussion Guide Other (Family History)_04 09 2015
F1 - Discussion Guide Other (Family History)_04 09 2015.docx
No
Fillable Printable
Form and Instruction
0920-0800
F2 - Materials for Testing_Other (Family History)_4 09 2015
F2 - Materials for Testing_Other (Family History)_4 09 2015.pdf
No
Fillable Printable
Instruction
G1 - Discussion Guide for Other (No Family History)_04 09 2015.docx
No
Fillable Printable
Form and Instruction
0920-0800
H - Screening Instrument for Ashkenazi Jewish Young Women
H - Screening Instrument for Ashkenazi Jewish Young Women.docx
No
Fillable Printable
Form and Instruction
0920-0800
I - Screening Instrument for African American Young Women
I - Screening Instrument for African American Young Women.docx
No
Fillable Printable
Form and Instruction
0920-0800
J - Screening Instrument for Other Young Women
J - Screening Instrument for Other Young Women.docx
No
Fillable Printable
Instruction
K - Participant Information Sheets_final.docx
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
540
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
540
0
540
0
0
0
Annual IC Time Burden (Hours)
378
0
378
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SS A v10_4 27 2015
SS A v10_4 27 2015.doc
04/30/2015
SS B v10_4 27 2015
SS B v10_4 27 2015.doc
04/30/2015
A Legislative Authority_Early Act Reauthorization
A Legislative Authority_Early Act Reauthorization.pdf
04/30/2015
Form 684
Form 684.pdf
04/30/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.