Screener and Core Questionnaire

A multi-center international hospital-based case-control study of lymphoma in Asia (AsiaLymph) (NCI)

Documents and Forms

Document Name Document Type
Form 1 Screener and Core Questionnaire Form and Instruction
1 Attachment 3A Updated Screener and Core Questionnaire Ho Attach-3A-Updated-Screener-and-Core-Questionnaire-Hong-Kong-English.doc Form and Instruction
2 Attachment 3B Updated Screener and Core Questionnaire Ho Attach-3B-Updated-Screener-and-Core-Questionnaire-Hong-Kong-Chinese.doc Form and Instruction
3 Attachment 3C Updated Screener and Core Questionnaire Ch Attach-3C-Updated-Screener-and-Core-Questionnaire-Chengdu-English.doc Form and Instruction
4 Attachment 3D Updated Screener and Core Questionnaire Ch Attach-3D-Updated-Screener-and-Core-Questionnaire-Chengdu-Chinese.docx Form and Instruction
5 Attachment 3E Updated Screener and Core Questionnaire Ti Attach-3E-Updated-Screener-and-Core-Questionnaire-Tianjin-English.doc Form and Instruction
6 Attachment 3F Updated Screener and Core Questionnaire Ti Attach-3F-Updated-Screener-and-Core-Questionnaire-Tianjin-Chinese.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Screener and Core Questionnaire	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	Available Electronically?	Electronic Capability
Form and Instruction	1	Attachment 3A Updated Screener and Core Questionnaire Hong-Kong English	Attach-3A-Updated-Screener-and-Core-Questionnaire-Hong-Kong-English.doc	No	Fillable Fileable
Form and Instruction	2	Attachment 3B Updated Screener and Core Questionnaire Hong-Kong Chinese	Attach-3B-Updated-Screener-and-Core-Questionnaire-Hong-Kong-Chinese.doc	No	Fillable Fileable
Form and Instruction	3	Attachment 3C Updated Screener and Core Questionnaire Chengdu-English	Attach-3C-Updated-Screener-and-Core-Questionnaire-Chengdu-English.doc	No	Fillable Fileable
Form and Instruction	4	Attachment 3D Updated Screener and Core Questionnaire Chengdu-Chinese	Attach-3D-Updated-Screener-and-Core-Questionnaire-Chengdu-Chinese.docx	No	Fillable Fileable
Form and Instruction	5	Attachment 3E Updated Screener and Core Questionnaire Tianjin-English	Attach-3E-Updated-Screener-and-Core-Questionnaire-Tianjin-English.doc	No	Fillable Fileable
Form and Instruction	6	Attachment 3F Updated Screener and Core Questionnaire Tianjin-Chinese	Attach-3F-Updated-Screener-and-Core-Questionnaire-Tianjin-Chinese.doc	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,110	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,110	2,110
Annual IC Time Burden (Hours)	176	176
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.