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ABC Screener (Attachment 2)
Awareness and Beliefs About Cancer (ABC) Survey
OMB: 0925-0684
IC ID: 208639
OMB.report
HHS/NIH
OMB 0925-0684
ICR 201405-0925-002
IC 208639
( )
Documents and Forms
Document Name
Document Type
Form 1
ABC Screener (Attachment 2)
Form and Instruction
1 ABC Screener
Attach2_ABC Screener_2-11-2014.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
ABC Screener (Attachment 2)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
ABC Screener
Attach2_ABC Screener_2-11-2014.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
Clinical, Basic and Population-based Research Studies of hte National Institutes of Health (NIH)
FR Citation:
67 FR 60776
Number of Respondents:
14,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
14,000
0
6,000
0
0
8,000
Annual IC Time Burden (Hours)
1,167
0
500
0
0
667
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.