Colorectal Cancer Control Program Indirect/Non-Medical Cost Study

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0920-0963 Change Request 10 22 2013.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2013-10-22	Available
Att F. FIT protocol instructions.docx	Supplementary Document	Uploaded 2012-12-10	Available
Att D. COL protocol instructions.docx	Supplementary Document	Uploaded 2012-12-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
205257	FIT Questionnaire	Other-WORD	Modified
205256	Colonoscopy Questionnaire	Other-WORD	Modified

ICR Details

OMB Control No: 0920-0963	ICR Reference No: 201310-0920-003
Status: Historical Active	Previous ICR Reference No: 201301-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 20720
Title: Colorectal Cancer Control Program Indirect/Non-Medical Cost Study
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/23/2013
	Date Received in OIRA: 10/23/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	04/30/2014	04/30/2014
Responses	615	0	615
Time Burden (Hours)	181	0	181
Cost Burden (Dollars)	0	0	0

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Abstract: CDC is requesting non-substantive changes to this Information Collection Request. Colorectal Cancer (CRC is the second leading cause of cancer-related deaths among adults in the United States (USCS, 2010). The CDC is funding colorectal cancer screening program to increase screening relates among men and women aged 50 years and older. CDC requests approval for a one-year study to collect individual patient-level indirect/non-medical cost data from a subset of patients being screened for CFRC through this program.

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Authorizing Statute(s): US Code: 3 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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Colonoscopy Questionnaire
FIT Questionnaire

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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	615	615	0	0	0	0
Annual Time Burden (Hours)	181	181	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $108,175

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? Yes

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: 10/23/2013

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