OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics-Clinic Support Staff

IC 182544 under ICR 200910-0920-011 · OMB 0920-0769.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Clinic Support Staff Post-intervention Survey Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics-Clinic Support Staff Form
Clinic Support Staff Post-intervention Survey
Attachment_4c_Revised_Clinic_Support_Staff_Post-Intervention_Survey.doc 		Form
Attachment_5_Revised_Post_Clinic_Support_Staff_Cover_Letter.doc
Clinic Support Staff Cover Letter		IC Document
Attachment_6_Revised_Reminder_Postcard_Clinic_Staff.doc
Clinic Support Staff Reminder Postcard		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Yes No Printable Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 140 0 0 0 0 140
Annual IC Time Burden (Hours) 58 0 0 0 0 58
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Clinic Support Staff Cover Letter 10/15/2009
Clinic Support Staff Reminder Postcard 10/15/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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