Information Collection

Clinic-level Cervical Cancer Screening Data

IC 233708 under ICR 202009-0920-022 · OMB 0920-1046.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Clinic-level Cervical Cancer Screening Data	Form and Instruction
Att 7b_NBCCEDP Clinic Data Dictionary- CERVICAL.docx	Instruction
Screen shots of the Clinic Baseline and Annual Reporting Att 7_NBCCEDP Clinic-Level Data Collection Instrument.docx	Form and Instruction

IC Title:

Clinic-level Cervical 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:

table that charts list of 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 7b_NBCCEDP Clinic Data Dictionary- CERVICAL.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 %

table that charts list of burden
	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

table that charts IC Documents
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.