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Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics-Clinic Support Staff
Evaluation of an Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics
OMB: 0920-0769
IC ID: 182544
OMB.report
HHS/CDC
OMB 0920-0769
ICR 200910-0920-011
IC 182544
( )
Documents and Forms
Document Name
Document Type
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)
IC Title:
Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics-Clinic Support Staff
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
Form
none
Clinic Support Staff Post-intervention Survey
Attachment_4c_Revised_Clinic_Support_Staff_Post-Intervention_Survey.doc
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
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 %
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
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.