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[NCCDPHP] My Family Health Portrait Cancer mobile application

IC 260592 under ICR 202505-0920-006 · OMB 0920-1050.

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[NCCDPHP] My Family Health Portrait Cancer mobile application 0920-1050-23EI
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att 1_Mobile app evaluation questions.docx No   Paper Only
Form 0920-1050 Family Health Profiles Att 2_Screenshots of DCPC MFHP_In_App_Feedback.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

1,200 0
   
Individuals or Households
 
   100 %

  Requested 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 1,200 0 0 0 0 1,200
Annual IC Time Burden (Hours) 10 0 0 0 0 10
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Customer Feedback on My Family Health Portrait: Cancer Mobile Application Customer Service GenIC Clearance Template_MFHP Cancer_June 2023.docx 06/14/2023
0920-1050 SSA 0920-1050_Supporting Statement A_MFHP Cancer_June 2023.docx 06/14/2023
0920-1050 SSB 0920-1050_Supporting Statement B_MFHP Cancer.docx 06/09/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.