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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Clinician Post-intervention Survey	Form	Modified	Available
Clinic Support Staff Post-intervention Survey	Form	Modified	Available
Patient Post-intervention Survey	Form	Modified	Available
Supporting_Statement_B[1].doc	Supporting Statement B	Uploaded 2009-10-14	Available
Attachment_6_Changes_Reminder_Postcard_Clinicians.doc	Supplementary Document	Uploaded 2009-10-14	Available
Attachment_6_Changes_Reminder_Postcard_Clinic_Staff.doc	Supplementary Document	Uploaded 2009-10-14	Available
Attachment_5_Changes_Post_Clinician_Survey_Cover_Letter.doc	Supplementary Document	Uploaded 2009-10-14	Available
Attachment_5_Changes_Post_Clinic_Support_Staff_Cover_Letter.doc	Supplementary Document	Uploaded 2009-10-14	Available
Attachment_5_Changes_Post_Patient_Survey_Cover_letter.doc	Supplementary Document	Uploaded 2009-10-14	Available
Attachment_4d_Changes_Clinician_Post-Intervention_Survey.doc	Supplementary Document	Uploaded 2009-10-14	Available
Attachment_4c_Changes_Clinic_Support_Staff_Post-Intervention_Survey.doc	Supplementary Document	Uploaded 2009-10-14	Repair queued
Attachment_4b_Changes_Patient_Post-Intervention_Survey.doc	Supplementary Document	Uploaded 2009-10-14	Available
0920-0769_OMB_Table of Proposed Changes.doc	Supplementary Document	Uploaded 2009-10-14	Available
0920-0769_OMB_Change_Request_2.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2009-10-14	Available
Attachment 4b Patient Post-Intervention Survey.doc	Supplementary Document	Uploaded 2007-10-03	Available
Attachment_6_Revised_Reminder_Postcard_Clinicians.doc	Supplementary Document	Uploaded 2009-10-15	Available
Attachment_5_Revised_Post_Clinician_Survey_Cover_Letter.doc	Supplementary Document	Uploaded 2009-10-15	Available
Attachment_6_Revised_Reminder_Postcard_Clinic_Staff.doc	Supplementary Document	Uploaded 2009-10-15	Available
Attachment_5_Revised_Post_Clinic_Support_Staff_Cover_Letter.doc	Supplementary Document	Uploaded 2009-10-15	Available
Attachment_5_Revised_Post_Patient_Survey_Cover_letter.doc	Supplementary Document	Uploaded 2009-10-15	Available
OMB_CRC Intervention Study_11-16-05_Patient Intervention.pdf	Supplementary Document	Uploaded 2007-10-03	Available
Attachment 6 Reminder Postcard-Patient.doc	Supplementary Document	Uploaded 2007-10-03	Available
Attachment 7 Training Curriculum Summary.doc	Supplementary Document	Uploaded 2007-10-03	Available
Attachment 5 Patient Intervention Materials Cover Letters.doc	Supplementary Document	Uploaded 2007-10-03	Available
Supporting_Statement_A[1].doc	Supporting Statement A	Uploaded 2009-10-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
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	Form	Modified	Clinician Post-intervention Survey
182544	Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics-Clinic Support Staff	Form	Modified	Clinic Support Staff Post-intervention Survey
182543	Intervention to Increase Colorectal Cancer Screening-Post Intervention	Form	Modified	Patient Post-intervention Survey
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: 200910-0920-011
Status: Historical Active	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: Approved without change	Conclusion Date: 11/02/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/26/2009
Terms of Clearance:

table that charts list comparision

	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 a nonsubstantive change with 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
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 52334	09/05/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 51823	09/11/2007
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Evaluation of an Intervention to Increase Cancer Screening in Primary Clinics-Pre Intervention Only
Evaluation of an Intervention to Increase Colorectal Cancer Screenig in Primary Care Clinics - Clincians	none	Clinician Post-intervention Survey
Evaluation of an Intervention to Increase Colorectal Cancer Screening in Primary Care Clinice - Pre and Post Intervention
Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics-Clinic Support Staff	none	Clinic Support Staff Post-intervention Survey
Intervention to Increase Colorectal Cancer Screening-Post Intervention	none	Patient Post-intervention Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	6,894	6,894	0	0	0	0
Annual Time Burden (Hours)	2,332	2,332	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: 10/26/2009

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