Information Collection

Survey of Primary Care Physicians Practices Regarding Prostate Cancer Screening

IC 179788 under ICR 200803-0920-005 · OMB 0920-0746.

Documents and Forms

Documents and forms in this information collection
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 5. Survey Cover Letters.doc Attachment 5. Survey Cover Letters	IC Document
Attachment 6. Signature Postcard.doc Attachment 6. Signature Postcard	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 301

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	Approved	Previously Approved
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

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 5. Survey Cover Letters	Attachment 5. Survey Cover Letters.doc	04/09/2007
Attachment 6. Signature Postcard	Attachment 6. Signature Postcard.doc	04/09/2007

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