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

California Health Interview Survey Cancer Control Module (CHIS-CCM) 2009 (NCI)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.