Information Collection

Colorectal Cancer Population Survey

IC 208027 under ICR 201308-0920-003 · OMB 0920-0992.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.