Sub-study #3 Self-Affirmation REVISED

A Generic Submission for Theory Development and Validation (NCI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0645 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Sub-study #3 Self-Affirmation REVISED Form and Instruction
1 Self-Affirm Survey #3B_Attach_Self- Affirm Survey_Screenshots.doc Form and Instruction
#3_Justif Memo_Self-Affirm7_17_2012.doc #3_Justif Memo_Self-Affirm7_17_2012 IC Document
#3A_Attach_Self-Affirm Survey_Word format.doc #3A_Attach_Self-Affirm Survey_Word format IC Document
#3C_Attach_Readings.doc #3C_Attach_Readings IC Document
#3D_Attach IRB Approval.pdf #3D_Attach IRB Approval IC Document

Information Collection (IC) Details

IC Title:	Sub-study #3 Self-Affirmation REVISED	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	Self-Affirm Survey	#3B_Attach_Self- Affirm Survey_Screenshots.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	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	250	0	0	0	0	0
Annual IC Time Burden (Hours)	125	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
#3_Justif Memo_Self-Affirm7_17_2012	#3_Justif Memo_Self-Affirm7_17_2012.doc	08/31/2012
#3A_Attach_Self-Affirm Survey_Word format	#3A_Attach_Self-Affirm Survey_Word format.doc	08/31/2012
#3C_Attach_Readings	#3C_Attach_Readings.doc	08/31/2012
#3D_Attach IRB Approval	#3D_Attach IRB Approval.pdf	08/31/2012

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