Information Collection

Assessment of Colorectal Cancer Control Program Implementation at Health System Clinic Sites

IC 242474 under ICR 201711-0920-012 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Attachment D - CDC Colorectal Cancer Control Clinic Survey-Web Version.pdf Other-Web Version
0920-20PX Colo-rectal Cancer Control Program Survey Attachment C - CDC Colorectal Cancer Control Program Clinic Survey-Word Version.docx Form and Instruction
Attachment A - List of CRCCP Clinics.pdf List of CRCCP Clinics IC Document
Attachment B - List of CRCCP Awardees.pdf List of CRCCP Awardees IC Document
Attachment E - Clinic Survey Notification Email.docx Clinic Survey Notification Email IC Document
Attachment F - Clinic Survey Invitation Email.docx Clinic Survey Invitation Email IC Document
Attachment G - Clinic Survey Reminder Email to Non-Responders.docx Clinic Survey Reminder Email to Non-Responders IC Document
Attachment H - REDCap System Security Statement.pdf REDCap System Security Statement IC Document
CRC-ASSESS-SSA.docx SSA IC Document
CRC-ASSESS-SSB.docx SSB IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Assessment of Colorectal Cancer Control Program Implementation at Health System Clinic Sites	Agency IC Tracking Number:	0920-20PX

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
Other-Web Version			Attachment D - CDC Colorectal Cancer Control Clinic Survey-Web Version.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-20PX	Colo-rectal Cancer Control Program Survey	Attachment C - CDC Colorectal Cancer Control Program Clinic Survey-Word Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 393	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	393	393
Annual IC Time Burden (Hours)	131	131
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
List of CRCCP Clinics	Attachment A - List of CRCCP Clinics.pdf	06/26/2020
List of CRCCP Awardees	Attachment B - List of CRCCP Awardees.pdf	06/26/2020
Clinic Survey Notification Email	Attachment E - Clinic Survey Notification Email.docx	06/26/2020
Clinic Survey Invitation Email	Attachment F - Clinic Survey Invitation Email.docx	06/26/2020
Clinic Survey Reminder Email to Non-Responders	Attachment G - Clinic Survey Reminder Email to Non-Responders.docx	06/26/2020
REDCap System Security Statement	Attachment H - REDCap System Security Statement.pdf	06/26/2020
SSA	CRC-ASSESS-SSA.docx	06/29/2020
SSB	CRC-ASSESS-SSB.docx	06/29/2020

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