Information Collection

CHIS Cancer Control Module 2009 and Demographic Core for Adults (CHIS-CCM) (NCI)

IC 187238 under ICR 200811-0925-001 · OMB 0925-0598.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0598 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 CHIS Cancer Control Module 2009 and Demographic Core for Adults (CHIS-CCM) (NCI)	Form and Instruction
1 CHIS-CCM Module 2009 Attachment1_CHIS2009_Cancer_Control_Module _27OCT2008.pdf	Form and Instruction

IC Title:

CHIS Cancer Control Module 2009 and Demographic Core for Adults (CHIS-CCM) (NCI)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form and Instruction	1	CHIS-CCM Module 2009	Attachment1_CHIS2009_Cancer_Control_Module _27OCT2008.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24,075

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	24,075	24,075
Annual IC Time Burden (Hours)	3,210	3,210
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.