Case Investigation of Cervical Cancer Study Survey

Case Investigation of Cervical Cancer (CICC) Study

Documents and Forms

Document Name Document Type
Case Investigation of Cervical Cancer Study Survey Form
Case Investigation of Cervical Cancer Attachment 4a. CICC Survey English.docx Form
Case Investigation of Cervical Cancer - Spanish Attachment 4b. CICC Survey Spanish.docx Form
CICC OMB cervivor change request attachment.docx Case Investigation of Cervical Cancer (CICC) Study - Cervivor IC Document

Information Collection (IC) Details

IC Title:	Case Investigation of Cervical Cancer Study Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Case Investigation of Cervical Cancer	Attachment 4a. CICC Survey English.docx		No		Paper Only
Form	none	Case Investigation of Cervical Cancer - Spanish	Attachment 4b. CICC Survey Spanish.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 418	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	418	418
Annual IC Time Burden (Hours)	105	105
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Case Investigation of Cervical Cancer (CICC) Study - Cervivor	CICC OMB cervivor change request attachment.docx	04/27/2018

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