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CRC Pre-Test Participants Including Control Group
Colorectal Cancer Screening Survey
OMB: 0920-1023
IC ID: 211512
OMB.report
HHS/CDC
OMB 0920-1023
ICR 201501-0920-013
IC 211512
( )
Documents and Forms
Document Name
Document Type
CRC Pre-Test Participants Including Control Group
Form
Overview of CRC Screening Survey
Att 2 Overview of Survey and Screen Shots REV 12JAN2015.docx
Form
Attachment 3 Experimental Design and 10 Blocks of DCE Questions.docx
Overview of Experimental Design
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CRC Pre-Test Participants Including Control Group
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
Overview of CRC Screening Survey
Att 2 Overview of Survey and Screen Shots REV 12JAN2015.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
677
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
677
0
0
0
0
677
Annual IC Time Burden (Hours)
248
0
0
0
0
248
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Overview of Experimental Design
Attachment 3 Experimental Design and 10 Blocks of DCE Questions.docx
05/05/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
