Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Early Detection Program

Minimum Data Elements for the National Breast and Cervical Cancer Early Detection Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0571 can be found here:

Documents and Forms

Document Name Document Type
Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Early Detection Program Form and Instruction
MDE Data Items and Definitions Required for Reporting Attachment 03a (MDE data items).pdf Form and Instruction
Web-based Portal Screenshot for MDE Submission Attachment 03b (Web-based portal).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Early Detection Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	MDE Data Items and Definitions Required for Reporting	Attachment 03a (MDE data items).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	none	Web-based Portal Screenshot for MDE Submission	Attachment 03b (Web-based portal).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

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	Previously Approved
Annual Number of Responses for this IC	134	134
Annual IC Time Burden (Hours)	536	536
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.