NBCCEDP Quarterly Program Update

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

Documents and Forms

Document Name Document Type
Form 0920-1046 NBCCEDP Quarterly Program Update Form and Instruction
0920-1046 NBCCEDP Quarterly Program Update Att 7 - NBCCEDP Quarterly Program Update.docx Form and Instruction
0920-1046 NBCCEDP Quarterly Program Update Att 7 - NBCCEDP Quarterly Program Update.docx Form and Instruction
Att 7a - NBCCEDP Quarterly Program Update (screenshots).docx NBCCEDP Quarterly Program Update (screenshots) IC Document
Att 7a - NBCCEDP Quarterly Program Update (screenshots).docx NBCCEDP Quarterly Program Update (screenshots) IC Document
Att 7b - NBCCEDP Quarterly Program Update Administration Email.docx NBCCEDP Quarterly Program Update Administration Email IC Document
Att 7b - NBCCEDP Quarterly Program Update Administration Email.docx NBCCEDP Quarterly Program Update Administration Email IC Document
Att 7c - NBCCEDP Quarterly Program Update Pre-Administration Email.docx NBCCEDP Quarterly Program Update Pre-Administration Email IC Document
Att 7c - NBCCEDP Quarterly Program Update Pre-Administration Email.docx NBCCEDP Quarterly Program Update Pre-Administration Email IC Document
Att 7d - NBCCEDP Quarterly Program Update Reminder Email.docx NBCCEDP Quarterly Program Update Reminder Email IC Document
Att 7d - NBCCEDP Quarterly Program Update Reminder Email.docx NBCCEDP Quarterly Program Update Reminder Email IC Document

Information Collection (IC) Details

IC Title:	NBCCEDP Quarterly Program Update	Agency IC Tracking Number:	0920-1046

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	0920-1046	NBCCEDP Quarterly Program Update	Att 7 - NBCCEDP Quarterly Program Update.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	280	280
Annual IC Time Burden (Hours)	149	149
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NBCCEDP Quarterly Program Update (screenshots)	Att 7a - NBCCEDP Quarterly Program Update (screenshots).docx	11/02/2021
NBCCEDP Quarterly Program Update Administration Email	Att 7b - NBCCEDP Quarterly Program Update Administration Email.docx	11/02/2021
NBCCEDP Quarterly Program Update Pre-Administration Email	Att 7c - NBCCEDP Quarterly Program Update Pre-Administration Email.docx	11/02/2021
NBCCEDP Quarterly Program Update Reminder Email	Att 7d - NBCCEDP Quarterly Program Update Reminder Email.docx	11/02/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.