2003 California Health Interview Survey (CHIS) Cancer Control Module (CCM)

ICR 200303-0925-004

OMB: 0925-0518

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0925-0518 200303-0925-004
Historical Active
HHS/NIH
2003 California Health Interview Survey (CHIS) Cancer Control Module (CCM)
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 05/05/2003
Retrieve Notice of Action (NOA) 03/28/2003
Approved for one year consistent with changes outlined in memo to OMB on May 1, 2003.
  Inventory as of this Action Requested Previously Approved
05/31/2004 05/31/2004
55,000 0 0
4,963 0 0
0 0 0

The 2003 California Health Interview Survey Cancer Control Module Adult Questionnaire will be sponsored by the NCI to provide better estimates for smaller racial-ethnic minority populations.

None
None


No

1
IC Title Form No. Form Name
2003 California Health Interview Survey (CHIS) Cancer Control Module (CCM)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 55,000 0 0 55,000 0 0
Annual Time Burden (Hours) 4,963 0 0 4,963 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/28/2003


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