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Questionnaire For Next-of-kin In An Epidemiologic Case-control Study Of Soft-tissue Sarcoma, Hodgkin's Disease, And Non-hodgkin's Lymphmaoma In Kansas

IC 111427 under ICR 198207-0925-002 · OMB 0925-0182.

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IC Title:	QUESTIONNAIRE FOR NEXT-OF-KIN IN AN EPIDEMIOLOGIC CASE-CONTROL STUDY OF SOFT-TISSUE SARCOMA, HODGKIN'S DISEASE, AND NON-HODGKIN'S LYMPHMAOMA IN KANSAS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 480	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	480	480
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	0	0

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