Cx3 Study - Patient Enrollment Form

CDC Cervical Cancer Study (CX3)

OMB: 0920-0814

IC ID: 188626

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Cx3 Study - Patient Enrollment Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att E1d_Patient enrollment form_0209.doc Yes Yes Fillable Printable

Health Illness Prevention

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

2,667 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 2,667 0 2,667 0 0 0
Annual IC Time Burden (Hours) 222 0 222 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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