Cx3 Study - Baseline Patient Survey

CDC Cervical Cancer Study (CX3)

OMB: 0920-0814

IC ID: 188624

Documents and Forms
Document Name
Document Type
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Information Collection (IC) Details

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Cx3 Study - Baseline Patient Survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att E1_HPV Baseline Patient Survey_0209.pdf Yes Yes Fillable Printable

Health Illness Prevention

09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems  57 FR 252

867 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 867 0 867 0 0 0
Annual IC Time Burden (Hours) 289 0 289 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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