OMB
.report
Search
National Comprehensive Cancer Control Program Survey
Development of an Evaluation Plan to Evaluate Grantee Attainment of Selected Activities of Comprehensive Cancer Priorities
OMB: 0920-0971
IC ID: 206291
OMB.report
HHS/CDC
OMB 0920-0971
ICR 201303-0920-015
IC 206291
( )
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
National Comprehensive Cancer Control Program Survey
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
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
Federal Enterprise Architecture Business Reference Module
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 %
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
69
0
69
0
0
0
Annual IC Time Burden (Hours)
35
0
35
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.