Health Status Questionnaire (HSQ) for PLCO

Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) (NCI)

OMB: 0925-0407

IC ID: 186212

Information Collection (IC) Details

View Information Collection (IC)

Health Status Questionnaire (HSQ) for PLCO
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 3A Health Status Questionnaire (Male-HSQ) Attach_03A_HSQ-Male9_24_12.doc No No Printable Only
Form and Instruction 3B Health Status Questionnaire (Female-HSQ) Attach_03B_HSQ-Female9_24_12.doc No No Printable Only

Health Consumer Health and Safety

09-25-0200, "Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH), HHS/NIH/OD"   67 FR 60776

2,000 0
   
Individuals or Households
 
   0 %

  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 2,000 0 0 0 0 2,000
Annual IC Time Burden (Hours) 167 0 0 0 0 167
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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