Evaluation of an Intervention to Increase Cancer Screening in Primary Clinics-Pre Intervention Only

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0769 can be found here:

Documents and Forms

Document Name Document Type
Attachment 4a Patient Pre-Intervention Survey.doc Instruction
Attachment 5 Patient Intervention Materials Cover Letters.doc Cover Letter IC Document
Attachment 7 Training Curriculum Summary.doc Training Curriculum Summary IC Document
Attachment 6 Reminder Postcard-Patient.doc Post Card Reminder IC Document
OMB_CRC Intervention Study_11-16-05_Patient Intervention.pdf Attachment 8 Patient Focused Intervention IC Document

Information Collection (IC) Details

IC Title:	Evaluation of an Intervention to Increase Cancer Screening in Primary Clinics-Pre Intervention Only	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Instruction			Attachment 4a Patient Pre-Intervention Survey.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 42 U.S.C. Code	FR Citation: 71 FR 52334

Number of Respondents: 2,335	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	2,335	2,335
Annual IC Time Burden (Hours)	778	778
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Cover Letter	Attachment 5 Patient Intervention Materials Cover Letters.doc	10/03/2007
Training Curriculum Summary	Attachment 7 Training Curriculum Summary.doc	10/03/2007
Post Card Reminder	Attachment 6 Reminder Postcard-Patient.doc	10/03/2007
Attachment 8 Patient Focused Intervention	OMB_CRC Intervention Study_11-16-05_Patient Intervention.pdf	10/03/2007

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