Information Collection

Supplemental Questionnaire (SQX) for PLCO

IC 198525 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 3 Supplemental Questionnaire (SQX) for PLCO Form
3 Supplemental Questionnaire (SQX). Attach_05_SQX.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Supplemental Questionnaire (SQX) for PLCO	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3	Supplemental Questionnaire (SQX).	Attach_05_SQX.doc		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: 09-25-0200, "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: 92,941	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	92,941	92,941
Annual IC Time Burden (Hours)	46,471	46,471
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.