Information Collection

Survey of Primary Care Physicians Practices Regarding Prostate Cancer Screening

IC 179788 under ICR 200704-0920-002 · OMB 0920-0746.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0746 can be found here:

Documents and Forms

Document Name Document Type
Survey of Primary Care Physicians Practices Regarding Prostate Cancer Screening Form and Instruction
Survey of Primary Care Physicians Practices Regarding Pr Attachment 4. Data Collection Instrument.doc Form and Instruction
Attachment 6. Signature Postcard.doc Attachment 6. Signature Postcard IC Document
Attachment 5. Survey Cover Letters.doc Attachment 5. Survey Cover Letters IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey of Primary Care Physicians Practices Regarding Prostate Cancer Screening	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 301

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Survey of Primary Care Physicians Practices Regarding Prostate Cancer Screening	Attachment 4. Data Collection Instrument.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 6. Signature Postcard	Attachment 6. Signature Postcard.doc
Attachment 5. Survey Cover Letters	Attachment 5. Survey Cover Letters.doc

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