CRCCP Clinic-level Information Collection

Colorectal Cancer Control Program (CRCCP) Monitoring Activities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1074 can be found here:

Documents and Forms

Document Name Document Type
CRCCP Clinic-level Information Collection Form
CRCCP Clinic-level Collection Attachment 4a - CRCCP Clinic-Level Collection Instrument (screenshots).pdf Form
Attachment 4b- CRCCP Clinic-Level Data dictionary_3 24 2016.docx CRCCP Clinic-level Data Dictionary IC Document
Attachment 4c- CRCCP Clinic-Level Collection Introductory Email.docx Clinic-level collection introductory email IC Document

Information Collection (IC) Details

IC Title:	CRCCP Clinic-level Information Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	CRCCP Clinic-level Collection	Attachment 4a - CRCCP Clinic-Level Collection Instrument (screenshots).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 31	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	372	372
Annual IC Time Burden (Hours)	186	186
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CRCCP Clinic-level Data Dictionary	Attachment 4b- CRCCP Clinic-Level Data dictionary_3 24 2016.docx	03/28/2016
Clinic-level collection introductory email	Attachment 4c- CRCCP Clinic-Level Collection Introductory Email.docx	03/28/2016

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