Clinic-level Breast Cancer Screening Data

National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Monitoring Activities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1046 can be found here:

Documents and Forms

Document Name Document Type
Clinic-level Breast Cancer Screening Data Form and Instruction
Att 7a_NBCCEDP Clinic Data Dictionary- BREAST.docx Instruction
Screen Shots of the Clinic Baseline and Annual Reporting Att 7_NBCCEDP Clinic-Level Data Collection Instrument.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Clinic-level Breast Cancer Screening Data	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 and Instruction	n/a	Screen Shots of the Clinic Baseline and Annual Reporting System (CBARS)	Att 7_NBCCEDP Clinic-Level Data Collection Instrument.docx		Yes	Yes	Fillable Fileable
Instruction			Att 7a_NBCCEDP Clinic Data Dictionary- BREAST.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	420	420
Annual IC Time Burden (Hours)	315	315
Annual IC Cost Burden (Dollars)	17,989	17,989

Documents for IC

Title	Document	Date Uploaded
No associated records found

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