Information Collection

Cost Assessment Tool

IC 179138 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.