Information Collection

Prostate Cancer Recurrence Questionnaire (PCRQ) for PLCO

IC 186213 under ICR 200808-0925-002 · OMB 0925-0407.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0407 can be found here:

Documents and Forms

Document Name Document Type
Form 4 Prostate Cancer Recurrence Questionnaire (PCRQ) for PLCO Form
4 Prostate Cancer Recurrence Questionnaire (PCRQ) Attachment 5 (PCRQ) revised 4-28-2008.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Prostate Cancer Recurrence Questionnaire (PCRQ) for PLCO	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: New

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
Form	4	Prostate Cancer Recurrence Questionnaire (PCRQ)	Attachment 5 (PCRQ) revised 4-28-2008.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,067	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	1,067	1,067
Annual IC Time Burden (Hours)	178	178
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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