Annual NBCCEDP Survey

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

Documents and Forms

Document Name Document Type
Form 0920-1046 Annual NBCCEDP Survey Form and Instruction
0920-1046 Annual National Breast and Cervical Early Detection Prog Att 5 - Annual NBCCEDP Survey.docx Form and Instruction
Att 5a - Annual NBCCEDP Survey (screenshots).docx NBCCEDP Annual Grantee Survey (Screenshots) IC Document

Information Collection (IC) Details

IC Title:	Annual NBCCEDP Survey	Agency IC Tracking Number:	0920-1046

Is this a Common Form? No		IC Status: Modified

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	Annual National Breast and Cervical Early Detection Program (NBCCEDP) Survey	Att 5 - Annual NBCCEDP Survey.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: 71	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	71	1	70
Annual IC Time Burden (Hours)	54	-11	65
Annual IC Cost Burden (Dollars)	0	-2,998	2,998

Documents for IC

Title	Document	Date Uploaded
NBCCEDP Annual Grantee Survey (Screenshots)	Att 5a - Annual NBCCEDP Survey (screenshots).docx	01/08/2025

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