CRCCP Annual Grantees Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 Annual Grantees Survey Form
CRCCP Grantee Survey Att 3a_CRCCP Annual Grantee Survey (screenshots).pdf Form
Att 3b_Survey Introductory Email_rev 4-10-17.docx Introductory Email IC Document
Att 3c_Survey Reminder Email_rev 4-10-17.docx Reminder Email IC Document

Information Collection (IC) Details

IC Title:	CRCCP Annual Grantees Survey	Agency IC Tracking Number:	0920-1074

Is this a Common Form? No		IC Status: Modified

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 Grantee Survey	Att 3a_CRCCP Annual Grantee Survey (screenshots).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	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	Previously Approved
Annual Number of Responses for this IC	30	-1	31
Annual IC Time Burden (Hours)	12	-11	23
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Introductory Email	Att 3b_Survey Introductory Email_rev 4-10-17.docx	05/01/2017
Reminder Email	Att 3c_Survey Reminder Email_rev 4-10-17.docx	05/01/2017

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