Information Collection

Case Investigation of Cervical Cancer Study Survey

IC 221992 under ICR 201804-0920-017 · OMB 0920-1162.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Case Investigation of Cervical Cancer Case Investigation of Cervical Cancer Study Survey	Form
Case Investigation of Cervical Cancer - Spanish 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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.