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View Information Collection (IC)

Bundled Sub-Studies #20 (Concise ICD), #21 (Accrual CT), and #22 (Spanish Consent)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Screener ICD #20_Attach 20B_Screener_ICD.pdf Yes Yes Fillable Fileable
Form and Instruction 2 Survey Screenshots ICD #20_Attach 20C_Survey_ICD.pdf No No Fillable Fileable
Form and Instruction 3 Oncology Survey Screenshots Accrual CT #21_Attach 21A Oncology Survey_AccrualCT.pdf No No Fillable Fileable
Form and Instruction 4 Staff Survey Screenshots Accrual CT #21_Attach 21B Staff Survey_AccrualCT.pdf Yes Yes Fillable Fileable
Form and Instruction 5 Concept Survey Screenshots Accrual CT #21_Attach 21C Concept Survey_AccrualCT.pdf Yes Yes Fillable Fileable
Form and Instruction 6 Prospective Survey Screenshots Accrual CT #21_Attach 21D Prospective template_AccrualCT.pdf Yes Yes Fillable Fileable
Form and Instruction 7 Screener Spanish Consent #22_Attach_22A_Consent_Screener.doc No No Printable Only
Form and Instruction 8 English Interview Guide - Spanish Consent #22_Attach_22B_Consent_Interview Guide-ENGLISH.doc No No Printable Only
Form and Instruction 9 Spanish Interview Guide - Spanish Consent #22_Attach_22C_Consent_Interview Guide-SPANISH.doc No No Printable Only

Health Consumer Health and Safety

 

450 0
   
Individuals or Households
 
   95 %

  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 450 0 0 0 0 0
Annual IC Time Burden (Hours) 232 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Memo Guide Memo to OMB_Key To Bundle #20_#21_#22.doc 03/29/2012
Gen IC Forms Bundle Gen IC Form_20-21-22_ICD_Accrual CT Rev_Consent.docx 03/29/2012
ICD Justif Memo_Email and Education Materials #20_Justif Memo & Attach 20A and 20D_ICD.docx 03/29/2012
Accrual CT Justif Memo_Email #21_Justif Memo & Attach 21E and 21F_Accrual CT.docx 03/29/2012
Spanish Consent_Sample Spanish Consent #22_Attach_22D_Sample Consent_SPANISH.doc 03/29/2012
Spanish Consent - Sample English Consent #22_Attach_22E_Sample Consent_ENGLISH.doc 03/29/2012
#22_Justif memo & Attach_22F_REVISED_Consent #22_Justif_Memo_Attach_22F_REVISED_Consent__4-19-12.doc 04/20/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.