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Att 3c_Web-based Screener (ONLY)
Understanding the Needs of Ovarian Cancer Survivors
OMB: 0920-1314
IC ID: 242265
OMB.report
HHS/CDC
OMB 0920-1314
ICR 202006-0920-008
IC 242265
( )
Documents and Forms
Document Name
Document Type
Form 0920-
Att 3c_Web-based Screener (ONLY)
Form
0920- Web-based Screener (Ovarian Cancer Survivorship Survey)
OCS Att 3c web-based screener & informed consent Final.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Att 3c_Web-based Screener (ONLY)
Agency IC Tracking Number:
0920-19BHM
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
0920-
Web-based Screener (Ovarian Cancer Survivorship Survey)
OCS Att 3c web-based screener & informed consent Final.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
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
100
0
100
0
0
0
Annual IC Time Burden (Hours)
3
0
3
0
0
0
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.