Cervical Cancer Screening Form

Individual Specific Medical Evaluation Forms (15)

Documents and Forms

Document Name Document Type
Form PC-262-11 Cervical Cancer Screening Form Form and Instruction
PC-262-11 Cervical Cancer Screening Form PC-262-11_Cervical Cancer Screening_2020.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Cervical Cancer Screening Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 22 CFR 305

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	PC-262-11	Cervical Cancer Screening Form	PC-262-11_Cervical Cancer Screening_2020.docx		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records
Title: PC-17	FR Citation: 85 FR 52382

Number of Respondents: 7,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,200	7,200
Annual IC Time Burden (Hours)	8,400	8,400
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.