View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

[CSTLTS] Pilot Reporting of Cancer Inquiries by the Public to STLT Partners 0920-0879-23EL
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Cancer Intake Inquiry Form - Redcap Attachment A- Intake Form REDCap.pdf Yes Yes Fillable Fileable
Form and Instruction n/a Cancer Intake Inquiry Form - EpiInfo Attachment B- Intake Form EpiInfo.pdf Yes Yes Fillable Fileable
Form and Instruction n/a Annual Report of Cancer Inquiries to STLTs Attachment D- Annual Report of Cancer Inquiries to STLTs.xlsx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

58 0
   
State, Local, and Tribal Governments
 
   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 580 0 580 0 0 0
Annual IC Time Burden (Hours) 117 0 117 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA CCG Intake Supporting Statement A_final.docx 04/27/2023
SSB CCG Intake Supporting Statement B.docx 04/27/2023
Cancer Intake Inquiry From - Word Attachment C- Intake Form Word.docx 04/27/2023
Cancer Intake Introductory Instructions Attachment E- Intake Form Introductory Instructions.docx 04/27/2023
Invitation Email Attachment F- Invitation Email.docx 04/27/2023
Reminder Email Attachment G- Reminder Email.docx 04/27/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.