Information Collection

Adults at High Risk for Cancer Survey

IC 235388 under ICR 201903-0920-002 · OMB 0920-1272.

Documents and Forms

Document Name Document Type
Form 0920-18AWP Adults at High Risk for Cancer Survey Form and Instruction
0920-18AWP High Risk Survey Attachment 3c High Risk Survey- FINAL ICRO.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adults at High Risk for Cancer Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	0920-18AWP	High Risk Survey	Attachment 3c High Risk Survey- FINAL ICRO.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 750	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

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.