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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.