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Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 0920-1046 ยท HHS/CDC.

OMB 0920-1046

This project will systematically collect information about implementation, including delivery of screening and follow-up clinical services, and outcomes of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which funds 71 recipients. In this Revision, CDC proposed use of three revised instruments - the annual NBCCEDP survey, clinic-level data collection, and quarterly program update (QPU) - and continued use of two instruments - the Service Delivery Projection Worksheet and MDEs - with no changes. The estimated burden will decrease from 1,220 to 1,162.

The latest form for [NCCDPHP] National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Monitoring Activities expires 2028-03-31 and is listed under ICR 202501-0920-002.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 0920-1046 Minimum Data Elements (MDE) Data Definition TableForm and Instruction
Form 0920-1046 Minimum Data Elements (MDE) Data Definition TableForm and Instruction
Form 0920-1046 NBCCEDP Service Delivery ProjectionsForm and Instruction
Form 0920-1046 NBCCEDP Service Delivery Projection WorksheetForm and Instruction
Form 0920-1046 NBCCEDP Quarterly Program UpdateForm and Instruction
Form 0920-1046 NBCCEDP Quarterly Program UpdateForm and Instruction
Form 0920-1046 NBCCEDP Clinic-Level Data Collection Instruments (Cervical)Form and Instruction
Form 0920-1046 NBCCEDP Clinic-Level Data Instrument (Cervical)Form and Instruction
Form 0920-1046 NBCCEDP Clinic-Level Data Collection InstrumentsForm and Instruction
Form 0920-1046 NBCCEDP Clinic-Level Data Collection InstrumentsForm and Instruction
Form 0920-1046 Annual National Breast and Cervical Early Detection Program (NBCCEDP) SurveyForm and Instruction
Form 0920-1046 Annual NBCCEDP SurveyForm and Instruction
Att 11a - CDC Responses to Public Comments.docx (document unavailable)Public Comments
0920-1046_PIA final.pdfSupplementary Document
0920-1046_PIA final.pdf Supplementary Document
Att 11 - 60 Day Federal Register Notice.pdfSupplementary Document
Att 10 - Institutional Review Board Approval.pdfSupplementary Document
Att 7d - NBCCEDP Quarterly Program Update Reminder Email.docxSupplementary Document
Att 7c - NBCCEDP Quarterly Program Update Administration Email.docxSupplementary Document
Att 7b - NBCCEDP Quarterly Program Update Pre-Administration Email.docxSupplementary Document
Att 6c - NBCCEDP Clinic-Level Data Collection Reminder Email.docxSupplementary Document
Att 6b - NBCCEDP Clinic-Level Data Collection Introductory Email.docxSupplementary Document
Att 5c - Annual NBCCEDP Survey Reminder Email_v2.docxSupplementary Document
Att 5b - Annual NBCCEDP Survey Introductory Email_v2.docxSupplementary Document
Att 4 - NBCCEDP Data Collection Revision Matrix.docxSupplementary Document
Att 3 - DP22-2202 NBCCEDP Logic Model.pdfSupplementary Document
Att 2 - Breast and Cervical Cancer Mortality Prevention Act of 1990.pdfSupplementary Document
Att 1 - Authorizing Legislation.pdfSupplementary Document
0920-1046 SS Part B_Revision.docxSupporting Statement B
0920-1046 SS Part B_Revision.docxSupporting Statement B
0920-1046 SS Part A Revision_rev_final.docxSupporting Statement A
0920-1046 SS Part A Revision_rev_final.docxSupporting Statement A
Minimum Data Elements (MDE) Data Definition Table Form and Instruction
Minimum Data Elements (MDE) Data Definition Table Form and Instruction
NBCCEDP Service Delivery Projection Worksheet Form and Instruction
NBCCEDP Service Delivery Projection Worksheet Form and Instruction
NBCCEDP Quarterly Program Update Form and Instruction
NBCCEDP Quarterly Program Update Form and Instruction
NBCCEDP Clinic-Level Data Instrument (Cervical) Form and Instruction
NBCCEDP Clinic-Level Data Instrument (Cervical) Form and Instruction
NBCCEDP Clinic-Level Data Collection Instruments Form and Instruction
NBCCEDP Clinic-Level Data Collection Instruments Form and Instruction
Annual NBCCEDP Survey Form and Instruction
Annual NBCCEDP Survey Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202501-0920-002 Revision of a currently approved collection 2025-01-13
202111-0920-005 Revision of a currently approved collection 2021-11-18 Approved without change
202009-0920-022 No material or nonsubstantive change to a currently approved collection 2020-09-28 Approved without change
201805-0920-008 Reinstatement with change of a previously approved collection 2018-10-31 Approved without change
201410-0920-018 New collection (Request for a new OMB Control Number) 2014-10-27 Approved without change

OMB Details

Annual NBCCEDP Survey

Federal Enterprise Architecture: Health - Consumer Health and Safety

Information collection instruments
FormNameElectronic accessType
Form 0920-1046Annual National Breast and Cervical Early Detection Program (NBCCEDP) SurveyFillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.