Information Collection

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

IC 7442 under ICR 200303-0925-004 · OMB 0925-0518.

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Information Collection (IC) Details

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IC Title:	2003 California Health Interview Survey (CHIS) Cancer Control Module (CCM)	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: 55,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 5 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	55,000	55,000
Annual IC Time Burden (Hours)	4,963	4,963
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.