NPCR - Program Evaluation Instrument (NPCR-PEI) (Paper)

National Program of Cancer Registries Program Evaluation Instrument

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0706 can be found here:

Documents and Forms

Document Name Document Type
Form CDC.0920-0706 NPCR - Program Evaluation Instrument (NPCR-PEI) (Paper) Form
CDC.0920-0706 NPCR Program Evaluation Instrument Att 3A NPCR Program Evaluation Instrument.docx Form
Att 3B_0706_Sample Letter w Inst_2017.docx Att 3b - Sample Letter IC Document
Att 3C_Summary of Proposed Changes.pdf Att 3c - Summary of Changes IC Document

Information Collection (IC) Details

IC Title:	NPCR - Program Evaluation Instrument (NPCR-PEI) (Paper)	Agency IC Tracking Number:	0920-0706

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CDC.0920-0706	NPCR Program Evaluation Instrument	Att 3A NPCR Program Evaluation Instrument.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3	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
Annual Number of Responses for this IC	3	3
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 3b - Sample Letter	Att 3B_0706_Sample Letter w Inst_2017.docx	11/30/2017
Att 3c - Summary of Changes	Att 3C_Summary of Proposed Changes.pdf	11/30/2017

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