Information Collection

Screening Practices: Survey of Primary Care Providers

IC 208028 under ICR 201308-0920-003 · OMB 0920-0992.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screening Practices: Survey of Primary Care Providers	Form
Survey of Primary Care Providers ATT 5A Colorectal Cancer Provider Survey_7.18.2013.doc	Form
ATT 5B Provider Survey Invitation Cover Letter.docx Att 5b - Invitation	IC Document
ATT 5C Advance Fax for Provider Survey.docx Att 5c - Advance FAX	IC Document
ATT 5D Reminder Fax for Provider Survey.docx Att 5d - Reminder FAX	IC Document
ATT 5E Second Survey Mailing Cover Letter.docx Att 5e - Second Survey Letter	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	Survey of Primary Care Providers	ATT 5A Colorectal Cancer Provider Survey_7.18.2013.doc		No	No	Paper Only

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: 1,600

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,600	1,600
Annual IC Time Burden (Hours)	320	320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 5b - Invitation	ATT 5B Provider Survey Invitation Cover Letter.docx	07/22/2013
Att 5c - Advance FAX	ATT 5C Advance Fax for Provider Survey.docx	07/22/2013
Att 5d - Reminder FAX	ATT 5D Reminder Fax for Provider Survey.docx	07/22/2013
Att 5e - Second Survey Letter	ATT 5E Second Survey Mailing Cover Letter.docx	07/22/2013

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