Information Collection

Phase 2 Women's Cancer Program Summit

IC 216327 under ICR 201504-0925-007 · OMB 0925-0722.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0722 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 11 Phase 2 Women's Cancer Program Summit	Form and Instruction
11 Women's Cancer Program Summit (English) 4E Women’s Cancer Program Summit (English) (ss).doc	Form and Instruction
12 Women's Cancer Program Summit (Spanish) 4F Women’s Cancer Program Summit (Spanish) (ss).doc	Form and Instruction

IC Title:

Phase 2 Women's Cancer Program Summit

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	11	Women's Cancer Program Summit (English)	4E Womenâs Cancer Program Summit (English) (ss).doc		Yes	Yes	Fillable Fileable
Form and Instruction	12	Women's Cancer Program Summit (Spanish)	4F Womenâs Cancer Program Summit (Spanish) (ss).doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 140

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	140	140
Annual IC Time Burden (Hours)	47	47
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.