Web-based Survey to Communicate Cancer

Pretesting of NCI's Office of Communications Messages

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0046 can be found here:

Documents and Forms

Document Name Document Type
Form Form #1 Web-based Survey to Communicate Cancer Form and Instruction
Form #1 HAN Risk Survey OMB Han RISK Survey Rev _ 5-15-08.doc Form and Instruction
Mini Supporting Statement Han RISK Rev _5-15-08.doc Mini Supporting Statement for the HAN Risk Survey IC Document

Information Collection (IC) Details

IC Title:	Web-based Survey to Communicate Cancer	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	Form #1	HAN Risk Survey	OMB Han RISK Survey Rev _ 5-15-08.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	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	200	0	0	0	0	0
Annual IC Time Burden (Hours)	40	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Mini Supporting Statement for the HAN Risk Survey	Mini Supporting Statement Han RISK Rev _5-15-08.doc	10/07/2008

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