Fourth Survey CORE Module (Attachment 1A)

Cancer Risk in U.S. Radiologic Technologists: Fourth Survey (NCI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0656 can be found here:

Documents and Forms

Document Name Document Type
Form 1A Fourth Survey CORE Module (Attachment 1A) Form and Instruction
1A CORE module Attachment 1A-USRT_4Survey_091411.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Fourth Survey CORE Module (Attachment 1A)	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 and Instruction	1A	CORE module	Attachment 1A-USRT_4Survey_091411.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: SORN #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: 21,700	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	21,700	21,700
Annual IC Time Burden (Hours)	10,850	10,850
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.