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⚠️ Notice: This information collection may be referencing outdated material.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: 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 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	Previously Approved
Annual Number of Responses for this IC	420	0	420
Annual IC Time Burden (Hours)	350	35	315
Annual IC Cost Burden (Dollars)	17,989	0	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.