Information Collection

[NCCDPHP] Cancer Screening Change Package Evaluation

IC 260719 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⚠️ Notice: This information collection may be referencing outdated material.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 [NCCDPHP] Cancer Screening Change Package Evaluation	Form and Instruction
Form 0920-1050 Cancer Screening Change Package Evaluation Survey [NCCDPHP] Cancer Screening Change Package Evaluation	Form and Instruction
0920-1050 Cancer Screening Change Package Evaluation Survey Appendix A_Cancer Screening Change Package Evaluation Survey_2_23_2023.docx	Form and Instruction
0920-1050 Cancer Screening Change Package Evaluation Survey Appendix A_Cancer Screening Change Package Evaluation Survey_2_23_2023.docx	Form and Instruction
Appendix B_Email_2_23_2023.docx Email to Disseminate Cancer Screening Change Package Evaluation for Cancer Council Members	IC Document
Appendix B_Email_2_23_2023.docx Email to Disseminate Cancer Screening Change Package Evaluation for Cancer Council Members	IC Document
0920-1050_Supporting Statement A_CSCP eval.docx SSA	IC Document
0920-1050_Supporting Statement A_CSCP eval.docx SSA	IC Document
0920-1050_Supporting Statement B_CSCP eval.docx SSB	IC Document
0920-1050_Supporting Statement B_CSCP eval.docx SSB	IC Document
0920-1050_Customer_Service_GenIC_Clearance_Template_2_23_2023_Clean.docx Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-105	IC Document
0920-1050_Customer_Service_GenIC_Clearance_Template_2_23_2023_Clean.docx Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-105	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[NCCDPHP] Cancer Screening Change Package Evaluation

Agency IC Tracking Number:

0920-1050-23GE

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				Yes	Yes	Fillable Fileable

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: 135

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	135	135
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email to Disseminate Cancer Screening Change Package Evaluation for Cancer Council Members		06/20/2023
SSA		06/20/2023
SSB		06/20/2023
Request for Approval under the âGeneric Clearance for the Collection of Routine Customer Feedbackâ (OMB Control Number: 0920-1050)		06/20/2023

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

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