Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Early Detection Program

Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Earl

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0571 can be found here:

Documents and Forms

Document Name Document Type
Form No number Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Early Detection Program Form and Instruction
No number MDE Screening and Follow-up OMB_Attachment 03 (MDE60).pdf Form and Instruction
OMB_Attachment 04 (MDE60changes).pdf Proposed Changes to Currently Approved MDE Data Set IC Document

Information Collection (IC) Details

IC Title:	Minimum Data Elements/System for Technical Assistance Reporting for the National Breast and Cervical Cancer Early Detection Program	Agency IC Tracking Number:

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	No number	MDE Screening and Follow-up	OMB_Attachment 03 (MDE60).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 68	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	136	68	68
Annual IC Time Burden (Hours)	544	-1,156	1,700
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Proposed Changes to Currently Approved MDE Data Set	OMB_Attachment 04 (MDE60changes).pdf	05/06/2008

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