Information Collection

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

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

Documents and Forms

Documents and forms in this information collection
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

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.