Information Collection

NLM CervigramFinder and Boundary Marking Tool

IC 192102 under ICR 200906-0925-004 · OMB 0925-0476.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0476 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NLM CervigramFinder and Boundary Marking Tool	Form and Instruction
1 survey NLM LHC Physician Cervigram Survey.docx	Form and Instruction
NLM LHC Cervigram Generic Clearance Request Form.doc NLM LHC Cervigram Generic Clearance Request Form	IC Document
NLM LHC Cervigram Mini Supporting Statement.docx NLM LHC Cervigram Mini Supporting Statement	IC Document

IC Title:

NLM CervigramFinder and Boundary Marking Tool

Agency IC Tracking Number:

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	survey	NLM LHC Physician Cervigram Survey.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

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 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	400	0	0	0	0	0
Annual IC Time Burden (Hours)	33	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NLM LHC Cervigram Generic Clearance Request Form	NLM LHC Cervigram Generic Clearance Request Form.doc	02/23/2010
NLM LHC Cervigram Mini Supporting Statement	NLM LHC Cervigram Mini Supporting Statement.docx	02/23/2010

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