Information Collection

Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Early Detection Program

IC 7025 under ICR 200805-0920-005 · OMB 0920-0571.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0571 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form No number Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Early Detection Program	Form and Instruction
No number MDE Screening and Follow-up OMB_Attachment 03 (MDE60).pdf	Form and Instruction
OMB_Attachment 04 (MDE60changes).pdf Proposed Changes to Currently Approved MDE Data Set	IC Document

IC Title:

Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Early Detection Program

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form and Instruction	No number	MDE Screening and Follow-up	OMB_Attachment 03 (MDE60).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 68

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	136	68	68
Annual IC Time Burden (Hours)	544	-1,156	1,700
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Proposed Changes to Currently Approved MDE Data Set	OMB_Attachment 04 (MDE60changes).pdf	05/06/2008

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