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Follow-up Questionnaire
Risk Perception, Worry, and Use of Ovarian Cancer Screening among Women at High, Elevated, and Average Risk of Ovarian Cancer
OMB: 0920-0744
IC ID: 179711
OMB.report
HHS/CDC
OMB 0920-0744
ICR 200704-0920-001
IC 179711
( )
Documents and Forms
Document Name
Document Type
Follow-up Questionnaire
Form and Instruction
Follow-up Questionnaire
ATTACHMENT F.followup questionnaire.doc
Form and Instruction
ATTACHMENT I.reminderletter followup.doc
Reminder Letter for Follow-up
IC Document
ATTACHMENT J.followup thankyou letter.doc
Thank-you for Follow-up Participation
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Follow-up Questionnaire
Agency IC Tracking Number:
Is this a Common Form?
No
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
None
Follow-up Questionnaire
ATTACHMENT F.followup questionnaire.doc
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 62812
Number of Respondents:
533
Number of Respondents for Small Entity:
0
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
533
0
533
0
0
0
Annual IC Time Burden (Hours)
133
0
133
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Reminder Letter for Follow-up
ATTACHMENT I.reminderletter followup.doc
Thank-you for Follow-up Participation
ATTACHMENT J.followup thankyou letter.doc
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.