Information Collection Request

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

ICR 202111-0920-005 · OMB 0920-1046 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1046 Minimum Data Elements (MDE) Data Definition Table Form and Instruction New Repair queued
Form 0920-1046 NBCCEDP Service Delivery Projection Worksheet Form and Instruction New Repair queued
Form 0920-1046 NBCCEDP Quarterly Program Update Form and Instruction New Repair queued
Form 0920-1046 NBCCEDP Clinic-Level Data Instrument (Cervical) Form and Instruction Modified Available
Form 0920-1046 NBCCEDP Clinic-Level Data Collection Instruments Form and Instruction Modified Repair queued
Form 0920-1046 Annual NBCCEDP Survey Form and Instruction Modified Repair queued
0920-1046_PIA final.pdf Supplementary Document Uploaded 2021-11-02 Repair queued
Att 10 - Institutional Review Board Approval.docx Supplementary Document Uploaded 2021-11-02 Repair queued
Att 11 - NBCCEDP 60-Day FRN.pdf Supplementary Document Uploaded 2021-11-02 Repair queued
Att 4 -NBCCEDP Evaluation Question Matrix.docx Supplementary Document Uploaded 2021-11-01 Repair queued
Att 3 - DP22-2202 NBCCEDP Logic Model.docx Supplementary Document Uploaded 2021-11-01 Available
Att 2 - Breast and Cervical Cancer Mortality Prevention Act of 1990.pdf Supplementary Document Uploaded 2021-11-02 Repair queued
Att 1 - Authorizing Legislation.pdf Supplementary Document Uploaded 2021-11-02 Repair queued
0920-1046 SS Part B_Final.docx Supporting Statement B Uploaded 2021-11-01 Repair queued
SS Part A_Final.v2_0920-1046.docx Supporting Statement A Uploaded 2021-11-18 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
250030 Minimum Data Elements (MDE) Data Definition Table Form and Instruction New
250027 NBCCEDP Service Delivery Projection Worksheet Form and Instruction New
250010 NBCCEDP Quarterly Program Update Form and Instruction New
233708 NBCCEDP Clinic-Level Data Instrument (Cervical) Form and Instruction Modified
233707 NBCCEDP Clinic-Level Data Collection Instruments Form and Instruction Modified
233706 Annual NBCCEDP Survey Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 11/30/2021
1,400 910
1,228 764
38,976 38,976





table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,400 910 0 490 0 0
Annual Time Burden (Hours) 1,228 764 0 464 0 0
Annual Cost Burden (Dollars) 38,976 38,976 0 0 0 0


Reginfo record details
  No