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 Name	Document 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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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	Clinic Support Staff Post-intervention Survey	Attachment_4c_Revised_Clinic_Support_Staff_Post-Intervention_Survey.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 42 U.S.C. 241

FR Citation: 71 FR 52334

Number of Respondents: 140

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	140	140
Annual IC Time Burden (Hours)	58	58
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Clinic Support Staff Cover Letter	Attachment_5_Revised_Post_Clinic_Support_Staff_Cover_Letter.doc	10/15/2009
Clinic Support Staff Reminder Postcard	Attachment_6_Revised_Reminder_Postcard_Clinic_Staff.doc	10/15/2009

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