Information Collection

Prostate Supplemental Questionnaire

IC 194464 under ICR 201008-0925-005 · OMB 0925-0623.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0623 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Prostate Supplemental Questionnaire	Form and Instruction
3 Prostate Supplemental Questionnaire Attach 7 - Supp Questionnaire for Prostate-No.2.doc	Form and Instruction

IC Title:

Prostate Supplemental Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

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	3	Prostate Supplemental Questionnaire	Attach 7 - Supp Questionnaire for Prostate-No.2.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH), HHS/NIH/OD

FR Citation: 67 FR 60776

Number of Respondents: 125

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	125	125
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.