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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
NCI Cancer Information Service on Demographic and Smoking/Tobacco Use
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
Survey
OMB Appendix 2 ECRF data collection instrument.doc
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
49,400
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
4 %
Requested
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
49,400
0
0
0
0
49,400
Annual IC Time Burden (Hours)
1,976
0
153
0
0
1,823
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
JUSTIFICATION FOR REQUESTED CHANGES TO OMB 0925 revised 11-9-06
JUSTIFICATION FOR REQUESTED CHANGES TO OMB 0925 revised 11-9-06.doc
11/17/2006
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.