Information Collection

Prostate Cancer Recurrence Questionnaire (PCRQ) for PLCO

IC 186213 under ICR 201107-0925-004 · OMB 0925-0407.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0407 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Prostate Cancer Recurrence Questionnaire (PCRQ) for PLCO	Form
4 Prostate Cancer Recurrence Questionnaire (PCRQ) Attachment 5 (PCRQ) revised 4-28-2008.doc	Form

IC Title:

Prostate Cancer Recurrence Questionnaire (PCRQ) for PLCO

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	4	Prostate Cancer Recurrence Questionnaire (PCRQ)	Attachment 5 (PCRQ) revised 4-28-2008.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,067

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-1,067	1,067
Annual IC Time Burden (Hours)	-178	178
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.