FIT Questionnaire

Colorectal Cancer Control Program Indirect/Non-Medical Cost Study

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0963 can be found here:

Documents and Forms

Document Name Document Type
Att_H(english).FIT_questionnaire_screens.pdf Other-WORD
Att_H(spanish).FIT_questionnaire_screens.pdf Other-WORD
Att F. FIT protocol instructions.docx Att F IC Document

Information Collection (IC) Details

IC Title:	FIT Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-WORD			Att_H(english).FIT_questionnaire_screens.pdf		Yes	Yes	Fillable Printable
Other-WORD			Att_H(spanish).FIT_questionnaire_screens.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att F	Att F. FIT protocol instructions.docx	12/10/2012

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