Health Provider Formative Focus Group Testing for the Inside Knowledge: Get the Facts about Gynecologic Cancer Campaign

Focus Group Testing to Effectively Plan and Tailor Cancer Prevention and Control Communication Campaigns

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0800 can be found here:

Documents and Forms

Document Name Document Type
Health Provider Formative Focus Group Testing for the Inside Knowledge: Get the Facts about Gynecologic Cancer Campaign Form and Instruction
Screener for Gynecologists IC 4_Att 1_Screener for Gynecologists 4 14 2011.doc Form and Instruction
Screener for Primary Care Providers IC 4_Att 2_Screener for Primary Care Providers 4 14 2011.doc Form and Instruction
Moderator Guide IC 4_Att 4_Moderators Guide 4.14.11.doc Form and Instruction
IC 4_Att 3_Consent Form 4 14 2011.doc Consent IC Document
IC 4_Justification 4 14 2011.doc Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Health Provider Formative Focus Group Testing for the Inside Knowledge: Get the Facts about Gynecologic Cancer Campaign	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Screener for Gynecologists	IC 4_Att 1_Screener for Gynecologists 4 14 2011.doc	No	No	Fillable Fileable
Form and Instruction	none	Screener for Primary Care Providers	IC 4_Att 2_Screener for Primary Care Providers 4 14 2011.doc	No	No	Fillable Fileable
Form and Instruction	none	Moderator Guide	IC 4_Att 4_Moderators Guide 4.14.11.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 720	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 67 %

	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	720	0	0	0	0	0
Annual IC Time Burden (Hours)	384	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Consent	IC 4_Att 3_Consent Form 4 14 2011.doc	04/14/2011
Supporting Statement	IC 4_Justification 4 14 2011.doc	04/14/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.