IDI Guide for Program Staff Members (Private Sector)

Case Studies to Explore Interventions to Support, Build, and Provide Legacy Awareness for Young Breast Cancer Survivors

Documents and Forms

Document Name Document Type
Att 10c_IDI Funded Staff Members_9.11.13.docx Other-WORD
Att 11c_IDI Nonfunded Staff Members_9.11.13.docx Other-WORD

Information Collection (IC) Details

IC Title:	IDI Guide for Program Staff Members (Private Sector)	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
Other-WORD			Att 10c_IDI Funded Staff Members_9.11.13.docx		No	No	Printable Only
Other-WORD			Att 11c_IDI Nonfunded Staff Members_9.11.13.docx		No	No	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	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	35	35
Annual IC Time Burden (Hours)	35	35
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.