Information Collection

California Health Interview Survey 2005 (CHIS) 2005 Cancer Control Module (CCM)

IC 7468 under ICR 200412-0925-001 · OMB 0925-0544.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

California Health Interview Survey 2005 (CHIS) 2005 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:

table that charts list of 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: 55,150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	55,150	55,150
Annual IC Time Burden (Hours)	9,375	9,375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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

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