Information Collection

Clinical Data Elements (CCDE)

IC 179134 under ICR 201004-0920-014 · OMB 0920-0745.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0745 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Clinical Data Elements (CCDE)	Form and Instruction
1 Colorectal Cancer Control Program (CRCCP) Colorectal Can Attachment 3a CCDE Data Definition Table.docx	Form and Instruction
Attachment 3b CCDE Data Users Manual.docx Attachment 3b CCDE Data Users Manual	IC Document
ATTACHMENT 4abc Sample Feedback.doc ATTACHMENT 4abc Sample Feedback	IC Document
ATTACHMENT 3c CCDE Comparison Table.pdf ATTACHMENT 3c CCDE Comparison Table	IC Document

IC Title:

Clinical Data Elements (CCDE)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	1	Colorectal Cancer Control Program (CRCCP) Colorectal Cancer Clinical Data Elements (CCDE) Data Definition Table	Attachment 3a CCDE Data Definition Table.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	9,750	9,270	480
Annual IC Time Burden (Hours)	2,438	1,958	480
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 3b CCDE Data Users Manual	Attachment 3b CCDE Data Users Manual.docx	04/08/2010
ATTACHMENT 4abc Sample Feedback	ATTACHMENT 4abc Sample Feedback.doc	04/08/2010
ATTACHMENT 3c CCDE Comparison Table	ATTACHMENT 3c CCDE Comparison Table.pdf	04/08/2010

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