View Information Collection (IC)
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Sub-study #18_Cancer Imaging Program (CIP) Web Site Usability Testing
Agency IC Tracking Number:
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
1
Screener
Attach4_Screener_CIP.docx
No
No
Printable Only
Form and Instruction
2
Usability Test
Attach5_UsabilityScript_CIP.doc
No
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
SORN #09-25-0156, "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"
FR Citation:
67 FR 60743
Number of Respondents:
74
Number of Respondents for Small Entity:
8
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
74
0
0
0
0
0
Annual IC Time Burden (Hours)
28
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attach2_VolunteerAnnounce_CIP
Attach2_VolunteerAnnounce_CIP.doc
12/03/2012
Attach1_Consent_CIP
Attach1_Consent_CIP.doc
12/03/2012
Attach3_RecruitLetters_CIP
Attach3_RecruitLetters_CIP.docx
12/03/2012
Fast-Track_Request_Usability_Test_CIP
Fast-Track_Request_Usability_Test_CIP.doc
12/05/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.