Screening Practices: Survey of Primary Care Providers

Impact Evaluation of CDC's Colorectal Cancer Control Program

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Screening Practices: Survey of Primary Care Providers	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	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 %

	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

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.