Information Collection

National Comprehensive Cancer Control Program Survey

IC 206291 under ICR 201303-0920-015 · OMB 0920-0971.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
National Comprehensive Cancer Control Program Survey	Form and Instruction
Att 3B_Survey ScreenShots.pdf	Other-screen shots
National Comprehensive Cancer Control Program Survey Att 3A_Natl Comp Cancer Control Prog Survey_011413_Revised2.docx	Form and Instruction
Att 4_Survey intro email_011413_Revised.doc Att 4_Survey intro email_011413_Revised	IC Document
Att 5_Survey invitation email_011413_Revision.doc Att 5_Survey invitation email_011413_Revision	IC Document
Att 6_Survey reminder email_011413_Revised.doc Att 6_Survey reminder email_011413_Revised	IC Document
Att 7_Survey Thank you email_011413_Revised.doc Att 7_Survey Thank you email_011413_Revised	IC Document

IC Title:

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	None	National Comprehensive Cancer Control Program Survey	Att 3A_Natl Comp Cancer Control Prog Survey_011413_Revised2.docx		Yes	Yes	Fillable Fileable
Other-screen shots			Att 3B_Survey ScreenShots.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 69

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	69	69
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 4_Survey intro email_011413_Revised	Att 4_Survey intro email_011413_Revised.doc	03/21/2013
Att 5_Survey invitation email_011413_Revision	Att 5_Survey invitation email_011413_Revision.doc	03/21/2013
Att 6_Survey reminder email_011413_Revised	Att 6_Survey reminder email_011413_Revised.doc	03/21/2013
Att 7_Survey Thank you email_011413_Revised	Att 7_Survey Thank you email_011413_Revised.doc	03/21/2013

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