Impact Evaluation of CDC's Colorectal Cancer Control Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Interview with Grantee Partners	Form	New	Repair queued
Interview with Nongrantee Partners	Form	New	Available
Interview with Nongrantee Evaluators	Form	New	Available
Interview Guide	Form	New	Available
Interview with Nongrantee Partners	Form	New	Available
Interview Guide for Grantee Partners	Form	New	Available
Interview Guide for Grantee Evaluators	Form	New	Available
Att 7a - Grantee Program Staff Interview	Form	New	Available
Site Visit InstructionTemplate	Form	New	Available
Site Visit Interviewee Form	Form	New	Available
Survey of Primary Care Providers	Form	New	Available
Colorectal Cancer Population Survey	Form	New	Available
Screener	Form	New	Available
SS Part B_07 18 2013.doc	Supporting Statement B	Uploaded 2013-07-22	Available
ATT 12 ICF Macro IRB Approval.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 10 Observational Assessment Guide.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 9 Document Review Form.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 11 Non-disclosure Agreement for Data Collection Contractors 7.18.2013.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 2B Summary of Public Comments and CDC Response.pdf	Supplementary Document	Uploaded 2013-07-22	Available
ATT 2A 60 Day Federal Register Notice.pdf	Supplementary Document	Uploaded 2013-07-22	Available
ATT 1 Authorizing Legislation, Section 301 Public Health Service Act.doc	Supplementary Document	Uploaded 2013-07-22	Available
ATT 7D Informed Consent Form.docx	Supplementary Document	Uploaded 2013-07-31	Available
ATT 8D Informed Consent Form.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 8D Informed Consent Form.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 8D Informed Consent Form.docx	Supplementary Document	Uploaded 2013-07-31	Available
ATT 7D Informed Consent Form.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 7D Informed Consent Form.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 7D Informed Consent Form.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 6E Site Visit Confirmation Email.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 6D Nongrantee Site Visit Introductory Letter Email.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 6C Grantee Site Visit Introductory Letter Email.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 5E Second Survey Mailing Cover Letter.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 5D Reminder Fax for Provider Survey.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 5C Advance Fax for Provider Survey.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 5B Provider Survey Invitation Cover Letter.docx	Supplementary Document	Uploaded 2013-07-22	Available
ATT 4B Screen shots of the CATI Administration Population Survey.pdf	Supplementary Document	Uploaded 2013-07-29	Available
SS Part A_07 18 2013.docx	Supporting Statement A	Uploaded 2013-07-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208038	Interview with Grantee State and Local Partners	Form	New	Interview with Grantee Partners
208037	Interview with Nongrantee State and Local Partners	Form	New	Interview with Nongrantee Partners
208036	Interview with Non-grantee Evaluators	Form	New	Interview with Nongrantee Evaluators
208035	Interview with Non-grantee Program Staff	Form	New	Interview Guide
208034	Interview Guide for Non-Grantee Private Sector Partners	Form	New	Interview with Nongrantee Partners
208033	Interview Guide for Grantee Private Sector Partners	Form	New	Interview Guide for Grantee Partners
208032	Interview Guide for Grantee Evaluators	Form	New	Interview Guide for Grantee Evaluators
208031	Interview Guide for Grantee Program Staff	Form	New	Att 7a - Grantee Program Staff Interview
208030	Site Visit Instructions Template	Form	New	Site Visit InstructionTemplate
208029	Suggested Interviewees Form	Form	New	Site Visit Interviewee Form
208028	Screening Practices: Survey of Primary Care Providers	Form	New	Survey of Primary Care Providers
208027	Colorectal Cancer Population Survey	Form	New	Colorectal Cancer Population Survey
208026	Screener for Population Survey	Form	New	Screener

ICR Details

OMB Control No: 0920-0992	ICR Reference No: 201308-0920-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 20097
Title: Impact Evaluation of CDC's Colorectal Cancer Control Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/26/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/02/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	36 Months From Approved
Responses	14,456	0	0
Time Burden (Hours)	2,425	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC plans to conduct a study to examine whether CRCCP program activities increase state-level colorectal cancer screening rates and other proximal outcomes.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 50696	08/22/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 45201	07/26/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 13

table that charts list of burden

IC Title	Form No.	Form Name
Colorectal Cancer Population Survey	none	Colorectal Cancer Population Survey
Interview Guide for Grantee Evaluators	none	Interview Guide for Grantee Evaluators
Interview Guide for Grantee Private Sector Partners	none	Interview Guide for Grantee Partners
Interview Guide for Grantee Program Staff	none	Att 7a - Grantee Program Staff Interview
Interview Guide for Non-Grantee Private Sector Partners	none	Interview with Nongrantee Partners
Interview with Grantee State and Local Partners	none	Interview with Grantee Partners
Interview with Non-grantee Evaluators	none	Interview with Nongrantee Evaluators
Interview with Non-grantee Program Staff	none	Interview Guide
Interview with Nongrantee State and Local Partners	none	Interview with Nongrantee Partners
Screener for Population Survey	none	Screener
Screening Practices: Survey of Primary Care Providers	none	Survey of Primary Care Providers
Site Visit Instructions Template	none	Site Visit InstructionTemplate
Suggested Interviewees Form	none	Site Visit Interviewee Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	14,456	0	0	14,456	0	0
Annual Time Burden (Hours)	2,425	0	0	2,425	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $983,381

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/02/2013

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