Information Collection

Evaluation of an Intervention to Increase Colorectal Cancer Screening in Primary Care Clinice - Pre and Post Intervention

IC 182546 under ICR 200910-0920-011 · OMB 0920-0769.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 4a Patient Pre-Intervention Survey.doc	Instruction
Attachment 4b Patient Post-Intervention Survey.doc Attachment 4b Patient Post-Intervention Survey	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
Instruction			Attachment 4a Patient Pre-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: 972

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,944	1,944
Annual IC Time Burden (Hours)	648	648
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 4b Patient Post-Intervention Survey	Attachment 4b Patient Post-Intervention Survey.doc	10/03/2007

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