Evaluation of an Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics

Forms and Documents

Document Name	Status
Attachment_5_Changes_Post_Clinician_Survey_Cover_Letter.doc Supplementary Document	2009-08-31
Attachment_6_Revised_Reminder_Postcard_Clinicians.doc Supplementary Document	2009-08-31
Attachment_6_Revised_Reminder_Postcard_Clinic_Staff.doc Supplementary Document	2009-08-31
Attachment_6_Changes_Reminder_Postcard_Clinicians.doc Supplementary Document	2009-08-31
Attachment_6_Changes_Reminder_Postcard_Clinic_Staff.doc Supplementary Document	2009-08-31
Attachment_5_Revised_Post_Clinician_Survey_Cover_Letter.doc Supplementary Document	2009-08-31
Attachment_5_Revised_Post_Clinic_Support_Staff_Cover_Letter.doc Supplementary Document	2009-08-31
Attachment_5_Changes_Post_Clinic_Support_Staff_Cover_Letter.doc Supplementary Document	2009-08-31
Attachment_5_Changes_Post_Patient_Survey_Cover_letter.doc Supplementary Document	2009-08-31
Attachment_5_Changes_Post_Patient_Survey_Cover_letter.doc Supplementary Document	2009-08-31
Attachment_4d_Revised_Clinician_Post-Intervention_Survey.doc Supplementary Document	2009-08-31
Attachment_4d_Changes_Clinician_Post-Intervention_Survey.doc Supplementary Document	2009-08-31
Attachment_4c_Revised_Clinic_Support_Staff_Post-Intervention_Survey.doc Supplementary Document	2009-08-31
Attachment_4c_Changes_Clinic_Support_Staff_Post-Intervention_Survey.doc Supplementary Document	2009-08-31
Attachment_4b_Revised_Patient_Post-Intervention_Survey.doc Supplementary Document	2009-08-31
Attachment_4b_Changes_Patient_Post-Intervention_Survey.doc Supplementary Document	2009-08-31
0920-0769_OMB_Table of Proposed Changes.doc Supplementary Document	2009-08-31
0920-0769_OMB_Change_Request_2.doc Justification for No Material/Nonsubstantive Change	2009-08-31
Attachment 4b Patient Post-Intervention Survey.doc Supplementary Document	2007-10-03
Attachment 6 Reminder Postcard Clinicians.doc Supplementary Document	2007-10-03
Attachment 5 Post Clinician Survey Cover Letter.doc Supplementary Document	2007-10-03
Attachment 6 Reminder Postcard Clinic Staff.doc Supplementary Document	2007-10-03
Attachment 5 Post Clinic Support Staff Cover Letter.doc Supplementary Document	2007-10-03
Attachment 5 Post Patient Survey Cover letter.doc Supplementary Document	2007-10-03
OMB_CRC Intervention Study_11-16-05_Patient Intervention.pdf Supplementary Document	2007-10-03
Attachment 6 Reminder Postcard-Patient.doc Supplementary Document	2007-10-03
Attachment 7 Training Curriculum Summary.doc Supplementary Document	2007-10-03
Attachment 5 Patient Intervention Materials Cover Letters.doc Supplementary Document	2007-10-03

IC Document Collections

IC ID	Document Title	Status
182546	Evaluation of an Intervention to Increase Colorectal Cancer Screening in Primary Care Clinice - Pre and Post Intervention Instruction	Modified
182545	Evaluation of an Intervention to Increase Colorectal Cancer Screenig in Primary Care Clinics - Clincians Instruction	Modified
182544	Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics-Clinic Support Staff Instruction	Modified
182543	Intervention to Increase Colorectal Cancer Screening-Post Intervention Instruction	Modified
182542	Evaluation of an Intervention to Increase Cancer Screening in Primary Clinics-Pre Intervention Only Instruction	Modified

ICR Details

OMB Control No: 0920-0769	ICR Reference No: 200909-0920-004
Status: Historical Inactive	Previous ICR Reference No: 200904-0920-012
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of an Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 10/13/2009
	Date Received in OIRA: 09/11/2009
Terms of Clearance: Supporting statements (A and B) must be submitted with the package.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2011	03/31/2011	03/31/2011
Responses	6,894	0	6,894
Time Burden (Hours)	2,332	0	2,332
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request for non-substantive changes to post-intervention surveys and letters. There is no change in burden.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Evaluation of an Intervention to Increase Cancer Screening in Primary Clinics-Pre Intervention Only
Intervention to Increase Colorectal Cancer Screening-Post Intervention
Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics-Clinic Support Staff
Evaluation of an Intervention to Increase Colorectal Cancer Screenig in Primary Care Clinics - Clincians
Evaluation of an Intervention to Increase Colorectal Cancer Screening in Primary Care Clinice - Pre and Post Intervention

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Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $791,402

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/11/2009

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