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

Documents and forms in this information collection
Document Name	Document Type
Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Early Detection Program	Form and Instruction
Web-based Portal Screenshot for MDE Submission Attachment 03b (Web-based portal).pdf	Form and Instruction
0920-0571 National Breast and Cervical Cancer Early Detection Prog ATT 5_MDE Data Definitions.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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 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

Line of Business: Health

Subfunction: Immunization Management

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	140	6	134
Annual IC Time Burden (Hours)	350	-186	536
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.