Information Collection

Survey Specific Tumor Site (Head & Neck, Breast, or Lung)

IC 210224 under ICR 201401-0925-008 · OMB 0925-0693.

Documents and Forms

Document Name Document Type
Form 2 Survey Specific Tumor Site (Head & Neck, Breast, or Lung) Form and Instruction
2 Breast Survey Att 2Bi - Screen shots of breast_updated - Dec 11 2013.docx Form and Instruction
1 Lung Survey Att 2Ci - Screen shots of lung_updated - Dec 11 2013.docx Form and Instruction
1 Head & Neck Att 2Ai - Screen shots of head neck survey_updated - Dec 11 2013.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey Specific Tumor Site (Head & Neck, Breast, or Lung)	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Breast Survey	Att 2Bi - Screen shots of breast_updated - Dec 11 2013.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1	Lung Survey	Att 2Ci - Screen shots of lung_updated - Dec 11 2013.docx	No	No	Fillable Fileable
Form and Instruction	1	Head & Neck	Att 2Ai - Screen shots of head neck survey_updated - Dec 11 2013.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	21	21
Annual IC Time Burden (Hours)	21	21
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.