Information Collection

Pilot Evaluation for Cervical Cancer Clinical Decision Support Tools

IC 255604 under ICR 202505-0920-006 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

2025-06-23 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1050 Pilot Evaluation for Cervical Cancer Clinical Decision Support Tools	Form and Instruction
Form 0920-1050 Usability Testing Script for CCSM CDS Interface Pilot Evaluation for Cervical Cancer Clinical Decision Support Tools	Form and Instruction
0920-1050 Usability Testing Script for CCSM CDS Interface CCSM Usability Script - Attachment B Usability Script.docx	Form and Instruction
0920-1050 Usability Testing Script for CCSM CDS Interface CCSM Usability Script - Attachment B Usability Script.docx	Form and Instruction
CCSM CDS Usability Testing Overview - Attachment A Instructions.docx Usability Evaluation and Analysis Overview for CCSM CDS Interface	IC Document
CCSM CDS Usability Testing Overview - Attachment A Instructions.docx Usability Evaluation and Analysis Overview for CCSM CDS Interface	IC Document
Customer Service GenIC Clearance Template (Final 5.3) for Cervical Cancer CDS Usability Evaluation .docx Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-105	IC Document
Customer Service GenIC Clearance Template (Final 5.3) for Cervical Cancer CDS Usability Evaluation .docx Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-105	IC Document
CCSM Usability Testing - Attachment C Participant Info.docx Participant Information Sheet for CCSM CDS Interface	IC Document
CCSM Usability Testing - Attachment C Participant Info.docx Participant Information Sheet for CCSM CDS Interface	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Pilot Evaluation for Cervical Cancer Clinical Decision Support Tools

Agency IC Tracking Number:

0920-1050-22IK

IC Status: Unchanged

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
Form and Instruction	0920-1050				No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 45

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	45	45
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Usability Evaluation and Analysis Overview for CCSM CDS Interface		08/25/2022
Request for Approval under the âGeneric Clearance for the Collection of Routine Customer Feedbackâ (OMB Control Number: 0920-1050)		08/25/2022
Participant Information Sheet for CCSM CDS Interface		08/29/2022

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

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