View Information Collection (IC)

View Information Collection (IC)

Evaluate Cervical and Lung Cancer Screening Questions 15YZ
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Screener Attach 3 - Phone Screener.docx No   Fillable Printable
Form none Questionnaire Attach 1 - Qnne.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population  49 FR 37693

112 0
   
Individuals or Households
 
   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 112 0 112 0 0 0
Annual IC Time Burden (Hours) 46 0 46 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Request for Approval 0920-0222 QDRL Cervlung2 032715.docx 04/02/2015
Flyer Attach 2 - Adflyer-updated.docx 04/02/2015
Informed Consent Attach 4 - Informed Consent.docx 04/02/2015
Special Consent Attach 5 - Special Consent.docx 04/02/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.