OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Breast Cancer in Young Women Survey

IC 220161 under ICR 201602-0920-011 · OMB 0920-1123.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Breast Cancer in Young Women Survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Breast Cancer in Young Women Attachment 3 - Mail-in Survey English_20160216.docx No   Paper Only
Form and Instruction none Breast Cancer in Young Women - Spanish Attachment 3s - Mail-in Survey Spanish_20160216.docx No   Paper Only
Form and Instruction none Breast Cancer in Young Women - online survey Attachment 4 - Web-based Survey Instrument English_20160212.pdf Yes Yes Fillable Fileable
Form and Instruction none Breast Cancer in Young Women - Spanish online survey Attachment 4s - Web-based Survey Instrument Spanish_20160212.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

1,200 0
   
Individuals or Households
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,200 0 1,200 0 0 0
Annual IC Time Burden (Hours) 440 0 440 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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