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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Annual Study Update (ASU) for PLCO
Removed
0
0
0
Form and Instruction
1
Annual Study Update (ASU)
Attachment 1 Annual Study Update Form
New
77281
6440
0
Form and Instruction
1
Annual Study Update
Attachment 11 Authorization to Release Medical Records
New
2700
135
0
Form and Instruction
5
Authorization to Release Medical Records
Attachment 2A HSQ Male
New
1040
87
0
Form and Instruction
2
HSQ Male
Attachment 2B HSQ Female
New
960
80
0
Form and Instruction
3
HSQ Female
Attachment 4 Medication Use Questionnaire (MUQ)
New
77281
19320
0
Form and Instruction
4
MUQ
Attachment 5 ASU Telephone Script
New
3091
258
0
Form and Instruction
5
ASU Telephone Script
Health Status Questionnaire (HSQ) for PLCO
Removed
0
0
0
Form and Instruction
3A
Health Status Questionnaire (Male-HSQ)
Form and Instruction
3B
Health Status Questionnaire (Female-HSQ)
Medication Use Questionnaire (MUQ) for PLCO
Removed
0
0
0
Form and Instruction
5
Medication Use Questionnaire (MUQ)
Script for Non-responders to ASU
Removed
0
0
0
Form and Instruction
6
Script for ASU Non-response
Total burden requested under this ICR:
162353
26320
0
To view an IC, click on IC Title