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  
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