Cx3 Study - Follow-up Patient Survey

CDC Cervical Cancer Study (CX3)

OMB: 0920-0814

IC ID: 188627

Information Collection (IC) Details

View Information Collection (IC)

Cx3 Study - Follow-up 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 E2_HPV Follow-up Patient Survey _0209.pdf No No Fillable Printable

Health Illness Prevention

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

624 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 624 0 624 0 0 0
Annual IC Time Burden (Hours) 104 0 104 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att E2b_Cover letter patient follow-up survey_0209 Att E2b_Cover letter patient follow-up survey_0209.doc 02/23/2009
Att E2c_Reminder postcard_0209 Att E2c_Reminder postcard_0209.doc 02/23/2009
Att E2a_Initial postcard_0209 Att E2a_Initial postcard_0209.doc 02/23/2009
Att E2d_Script for reminder phone call_0209 Att E2d_Script for reminder phone call_0209.doc 02/23/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy