NBCCEDP Annual Grantee Survey

National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Monitoring Activities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1046 can be found here:

Documents and Forms

Document Name Document Type
NBCCEDP Annual Grantee Survey Form and Instruction
NBCCEDP Annual Grantee Survey Att 6_NBCCEDP Grantee Survey.docx Form and Instruction

Information Collection (IC) Details

IC Title:	NBCCEDP Annual Grantee Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	n/a	NBCCEDP Annual Grantee Survey	Att 6_NBCCEDP Grantee Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	53	53
Annual IC Cost Burden (Dollars)	2,998	2,998

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.