Goals and Values in Physical Activity Sub-Study #7

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⚠️ Notice: This information collection may be referencing outdated material.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 2 Goals and Values in Physical Activity Sub-Study #7 Form and Instruction
1 Screener #7_attachB_screener_REV.DOC Form and Instruction
2 Survey #7_attachE_survey.docx Form and Instruction
3 Focus Group Protocol #7_attachF_focus group protocol.docx Form and Instruction
JustifMemo_0925-0645_Physical Activity 7 2 14.docx Gen IC Justification Memo IC Document
#7_attachA_advertisement_REV.DOC Attachment A- Advertisement IC Document
#7_attachC_phone reminder_REV.DOCX Attachment C- Phone Reminder IC Document
#7_attachD_consent_REV.DOC Attachment D- Revised Consent Form IC Document
#7_attachG_selectedreadings.doc Attachment G- Selected Readings IC Document
#7_attachH_OHSRP exemption.pdf Attachment H - IRB Letter IC Document

Information Collection (IC) Details

IC Title:	Goals and Values in Physical Activity Sub-Study #7	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	2	Survey	#7_attachE_survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Focus Group Protocol	#7_attachF_focus group protocol.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1	Screener	#7_attachB_screener_REV.DOC	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 296	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	296	296
Annual IC Time Burden (Hours)	108	108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Gen IC Justification Memo	JustifMemo_0925-0645_Physical Activity 7 2 14.docx	07/03/2014
Attachment A- Advertisement	#7_attachA_advertisement_REV.DOC	07/03/2014
Attachment C- Phone Reminder	#7_attachC_phone reminder_REV.DOCX	07/03/2014
Attachment D- Revised Consent Form	#7_attachD_consent_REV.DOC	07/03/2014
Attachment G- Selected Readings	#7_attachG_selectedreadings.doc	07/03/2014
Attachment H - IRB Letter	#7_attachH_OHSRP exemption.pdf	07/03/2014

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