Information Collection

Screen for Life: National Colorectal Cancer Action Campaign

IC 193889 under ICR 200906-0920-015 · OMB 0920-0800.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0800 can be found here:

Documents and Forms

Document Name Document Type
Screen for Life: National Colorectal Cancer Action Campaign Form
Recruitment screener SFL_Screener 6 29 10.doc Form
Moderator's guide SFL_Mod Guide 6 29 10.doc Form
Storyboards for OMB.PDF Storyboards IC Document
SFL_Consent Form.doc Consent form IC Document
PDFIC_3_ SFL Focus Groups 6 29 10.pdf PDF Supporting Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Screen for Life: National Colorectal Cancer Action Campaign	Agency IC Tracking Number:

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	none	Recruitment screener	SFL_Screener 6 29 10.doc		Yes	Yes	Fillable Fileable
Form	none	Moderator's guide	SFL_Mod Guide 6 29 10.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 432	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	648	0	0	0	0	0
Annual IC Time Burden (Hours)	346	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

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