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Federal forms, ICRs, and supporting documents

Information Collection

NBCCEDP Clinic-Level Data Collection Instruments

IC 233707 under ICR 202501-0920-002 · OMB 0920-1046.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
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NBCCEDP Clinic-Level Data Collection Instruments 0920-1046
 
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 0920-1046 NBCCEDP Clinic-Level Data Collection Instruments Att 6 - NBCCEDP Clinic-Level Data Collection Instruments.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

71 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 426 0 6 0 0 420
Annual IC Time Burden (Hours) 284 0 -31 0 0 315
Annual IC Cost Burden (Dollars) 0 0 -17,989 0 0 17,989

Title Document Date Uploaded
NBCCEDP Clinic-Level Data Instrument (Screenshots) Att 6a - NBCCEDP Clinic-Level Data Collection Instruments (screenshots).docx 01/08/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.