Annual Survey of NBCCEDP Grantees' Program Implementation

Annual Survey of the National Breast and Cervical Cancer Early Detection Program Grantees' Program Implementation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1046 can be found here:

Documents and Forms

Document Name Document Type
Annual Survey of NBCCEDP Grantees' Program Implementation Form
Annual Survey of NBCCEDP Grantees' Program Implementatio Attachment D2 - Data Collection Instrument Web Version.pdf Form
Attachment D1 - Data Collection Instrument - MS Word Version.docx Annual Survey - word IC Document

Information Collection (IC) Details

IC Title:	Annual Survey of NBCCEDP Grantees' Program Implementation	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	none	Annual Survey of NBCCEDP Grantees' Program Implementation	Attachment D2 - Data Collection Instrument Web Version.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 67	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 Agency Discretion
Annual Number of Responses for this IC	67	67
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Annual Survey - word	Attachment D1 - Data Collection Instrument - MS Word Version.docx	10/14/2014

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