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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 Young Women and Breast Cancer Communication Campaign
Agency IC Tracking Number:
0920-0800-19AJF
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
Discussion Guide for Hispanic (family history) Eng
Attachment B1. Discussion Guide for Hispanic (Family History)_English 2-4-19.docx
No
Fillable Fileable
Form and Instruction
0920-0800
Discussion Guide for Hispanic (family history) Spa
Attachment B2. Discussion Guide for Hispanic (Family History)_Spanish 3-14-19.docx
No
Fillable Fileable
Form and Instruction
0920-0800
Discussion Guide for Hispanic (no fam hist) Eng
Attachment B3. Discussion Guide for Hispanic (No Family History)_English 2-4-19.docx
No
Fillable Fileable
Form and Instruction
0920-0800
Discussion Guide for Hispanic (no fam hist) Spa
Attachment B4. Discussion Guide for Hispanic (No Family History)_Spanish 3-14-19.docx
No
Fillable Fileable
Form and Instruction
0920-0800
Discussion Guide for AA (family history)
Attachment C1. Discussion Guide for AA (With Family History) 2-4-19.docx
No
Fillable Fileable
Form and Instruction
0920-0800
Discussion Guide for AA (no fam hist)
Attachment C2. Discussion Guide for AA (Without Family History) 2-4-19.docx
No
Fillable Fileable
Form and Instruction
0920-0800
Discussion Guide for AIAN (family history)
Attachment D1. Discussion Guide for AIAN (Family History) 2-4-19.docx
No
Fillable Fileable
Form and Instruction
0920-0800
Discussion Guide for AIAN (no fam hist)
Attachment D2. Discussion Guide for AIAN (No Family History) 2-4-19.docx
No
Fillable Fileable
Form and Instruction
0920-0800
Screening Instrument Hispanic Eng
Attachment E1. Screening Instrument for Hispanic Young Women_English 2-4-19.docx
No
Fillable Fileable
Form and Instruction
0920-0800
Screening Instrument Hispanic Spa
Attachment E2. Screening Instrument for Hispanic Young Women_Spanish 3-14-19.docx
No
Fillable Fileable
Form and Instruction
0920-0800
Screening Instrument AA
Attachment F. Screening Instrument for African American Young Women 2-4-19.docx
No
Fillable Fileable
Form and Instruction
0920-0800
Screening Instrument AIAN
Attachment G. Screening Instrument for AIAN Young Women 2-4-19.docx
No
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:
594
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
594
0
594
0
0
0
Annual IC Time Burden (Hours)
317
0
317
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Legislative Authority
Attachment A. Legislative Authority - EARLY Act Reauthorization.pdf
03/29/2019
Materials for Testing Hispanic Eng
Attachment B5. Materials for Testing_Hispanic Young Women_English.pdf
03/29/2019
Materials for Testing Hispanic Spa
Attachment B6. Materials for Testing_Hispanic Young Women_Spanish.pdf
03/29/2019
Materials for Testing AA
Attachment C3. Materials for Testing_AA Young Women 2-4-19.pdf
03/29/2019
Materials for Testing AIAN
Attachment D3. Materials for Testing_AIAN Young Women.pdf
03/29/2019
Participant Information Sheet Eng
Attachment H1. Participant Information Sheet_English.docx
03/29/2019
Participant Information Sheet Spa
Attachment H2. Participant Information Sheet_Spanish.docx
03/29/2019
SSA
Supporting Statement Part A_v5 3-15-19 final.doc
03/29/2019
SSB
Supporting Statement Part B_v5 3-15-19.docx
03/29/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.