Colorectal Cancer Population Survey

Impact Evaluation of CDC's Colorectal Cancer Control Program

Documents and Forms

Document Name Document Type
Colorectal Cancer Population Survey Form
Colorectal Cancer Population Survey ATT 4A Colorectal Cancer Population Survey_7.18.2013.docx Form
ATT 4B Screen shots of the CATI Administration Population Survey.pdf Att 4b - Screenshots IC Document

Information Collection (IC) Details

IC Title:	Colorectal Cancer Population Survey	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
Form	none	Colorectal Cancer Population Survey	ATT 4A Colorectal Cancer Population Survey_7.18.2013.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 3,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	1,227	1,227
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 4b - Screenshots	ATT 4B Screen shots of the CATI Administration Population Survey.pdf	07/29/2013

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