Information Collection

CRCCP Clinic-level Information Collection

IC 220791 under ICR 202602-0920-008 · OMB 0920-1074.

Documents and Forms

Document Name Document Type
Form 0920-1074 CRCCP Clinic Data Collection Instrument CRCCP Clinic-level Information Collection Form
Form 0920-1074 Colorectal Cancer Control Program (CRCCP) Clinic Data Dictionary CRCCP Clinic-level Information Collection Form and Instruction
0920-1074 CRCCP Clinic Data Collection Instrument Attachment 5a - CRCCP Clinic Data Collection Instrument (screenshots).docx Form
0920-1074 Colorectal Cancer Control Program (CRCCP) Clinic Data Di Attachment 1 - CRCCP DP25 Clinic Data Dictionary_v2026_clean.docx Form and Instruction
Attachment 5b - CRCCP Clinic Data Dictionary.docx Attachment 5b - CRCCP Clinic Data Dictionary IC Document
Attachment 5c - CRCCP Clinic-Level Data Collection Introductory Email.docx Attachment 5c - CRCCP Clinic-Level Data Collection Introductory Email IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CRCCP Clinic-level Information Collection	Agency IC Tracking Number:	0920-1074

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	0920-1074	CRCCP Clinic Data Collection Instrument	Attachment 5a - CRCCP Clinic Data Collection Instrument (screenshots).docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1074	Colorectal Cancer Control Program (CRCCP) Clinic Data Dictionary	Attachment 1 - CRCCP DP25 Clinic Data Dictionary_v2026_clean.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	840	840
Annual IC Time Burden (Hours)	700	700
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 5b - CRCCP Clinic Data Dictionary	Attachment 5b - CRCCP Clinic Data Dictionary.docx	05/07/2024
Attachment 5c - CRCCP Clinic-Level Data Collection Introductory Email	Attachment 5c - CRCCP Clinic-Level Data Collection Introductory Email.docx	05/07/2024

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].