Information Collection

Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation

IC 265627 under ICR 202503-0906-002 · OMB 0906-0084.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation	Form and Instruction
Form 1 CERV-Net 3-Month Follow-Up Test Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation	Form and Instruction
Form 2 CERV-Net Post-Test Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation	Form and Instruction
Form 3 CERV-Net Pre-Test Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation	Form and Instruction
1 CERV-Net 3-Month Follow-Up Test 2024-02-13_CERV-Net 3-Month Follow-Up Test.pdf	Form and Instruction
1 CERV-Net 3-Month Follow-Up Test 2024-02-13_CERV-Net 3-Month Follow-Up Test.pdf	Form and Instruction
2 CERV-Net Post-Test 2024-02-13_CERV-Net Post-Test.pdf	Form and Instruction
2 CERV-Net Post-Test 2024-02-13_CERV-Net Post-Test.pdf	Form and Instruction
3 CERV-Net Pre-Test 2024-02-13_CERV-Net Pre-Test.pdf	Form and Instruction
3 CERV-Net Pre-Test 2024-02-13_CERV-Net Pre-Test.pdf	Form and Instruction
2023-02-13_FCCC_OMB-Review_Fast-Track-Memo_V2clean.docx Fast Track Memo_CERV Net	IC Document
2023-02-13_FCCC_OMB-Review_Fast-Track-Memo_V2clean.docx Fast Track Memo_CERV Net	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Yes	Yes	Fillable Fileable
Form and Instruction	2	Yes	Yes	Fillable Fileable
Form and Instruction	3	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Memo_CERV Net		02/26/2024

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

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