Cost Assessment Tool

Colorectal Cancer Screening Program

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 2 Cost Assessment Tool Form and Instruction
2 Colorectal Cancer Control Program Cost Assessment Tool-- Attachment 5a Cost Assessment Tool.xls Form and Instruction
Attachment 5b Cost Assessment Tool Users Manual.doc Attachment 5b Cost Assessment Tool Users Manual IC Document

Information Collection (IC) Details

IC Title:	Cost Assessment Tool	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Colorectal Cancer Control Program Cost Assessment Tool--User's Guide	Attachment 5a Cost Assessment Tool.xls		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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	26	21	5
Annual IC Time Burden (Hours)	572	567	5
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 5b Cost Assessment Tool Users Manual	Attachment 5b Cost Assessment Tool Users Manual.doc	04/08/2010

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