OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

IC 182542 under ICR 200910-0920-011 · OMB 0920-0769.

Documents and Forms
Document Name
Document Type
Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Evaluation of an Intervention to Increase Cancer Screening in Primary Clinics-Pre Intervention Only
 
No Modified
 
Voluntary
 

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

Health Illness Prevention

42 U.S.C. Code  71 FR 52334

2,335 0
   
Individuals or Households
 
   0 %

  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 2,335 0 0 0 0 2,335
Annual IC Time Burden (Hours) 778 0 0 0 0 778
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.