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Federal forms, ICRs, and supporting documents

Information Collection

Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Early Detection Program

IC 7025 under ICR 201902-0920-006 · OMB 0920-0571.

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

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Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Early Detection Program
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Web-based Portal Screenshot for MDE Submission Attachment 03b (Web-based portal).pdf Yes Yes Fillable Fileable
Form and Instruction 0920-0571 National Breast and Cervical Cancer Early Detection Program - Minimum Data Elements (MDEs) ATT 5_MDE Data Definitions.docx NA Yes Yes Fillable Fileable

Health Immunization Management

 

70 0
   
State, Local, and Tribal Governments
 
   100 %

  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 140 0 6 0 0 134
Annual IC Time Burden (Hours) 350 0 -186 0 0 536
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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