OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Evaluation of an Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics

ICR 200909-0920-004 · OMB 0920-0769 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
Attachment_5_Changes_Post_Clinician_Survey_Cover_Letter.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_6_Revised_Reminder_Postcard_Clinicians.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_6_Revised_Reminder_Postcard_Clinic_Staff.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_6_Changes_Reminder_Postcard_Clinicians.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_6_Changes_Reminder_Postcard_Clinic_Staff.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_5_Revised_Post_Clinician_Survey_Cover_Letter.doc Supplementary Document Uploaded 2009-08-31 Repair queued
Attachment_5_Revised_Post_Clinic_Support_Staff_Cover_Letter.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_5_Changes_Post_Clinic_Support_Staff_Cover_Letter.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_5_Changes_Post_Patient_Survey_Cover_letter.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_5_Changes_Post_Patient_Survey_Cover_letter.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_4d_Revised_Clinician_Post-Intervention_Survey.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_4d_Changes_Clinician_Post-Intervention_Survey.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_4c_Revised_Clinic_Support_Staff_Post-Intervention_Survey.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_4c_Changes_Clinic_Support_Staff_Post-Intervention_Survey.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_4b_Revised_Patient_Post-Intervention_Survey.doc Supplementary Document Uploaded 2009-08-31 Available
Attachment_4b_Changes_Patient_Post-Intervention_Survey.doc Supplementary Document Uploaded 2009-08-31 Available
0920-0769_OMB_Table of Proposed Changes.doc Supplementary Document Uploaded 2009-08-31 Available
0920-0769_OMB_Change_Request_2.doc Justification for No Material/Nonsubstantive Change Uploaded 2009-08-31 Available
Attachment 4b Patient Post-Intervention Survey.doc Supplementary Document Uploaded 2007-10-03 Available
Attachment 6 Reminder Postcard Clinicians.doc Supplementary Document Uploaded 2007-10-03 Available
Attachment 5 Post Clinician Survey Cover Letter.doc Supplementary Document Uploaded 2007-10-03 Available
Attachment 6 Reminder Postcard Clinic Staff.doc Supplementary Document Uploaded 2007-10-03 Available
Attachment 5 Post Clinic Support Staff Cover Letter.doc Supplementary Document Uploaded 2007-10-03 Available
Attachment 5 Post Patient Survey Cover letter.doc Supplementary Document Uploaded 2007-10-03 Repair queued
OMB_CRC Intervention Study_11-16-05_Patient Intervention.pdf Supplementary Document Uploaded 2007-10-03 Available
Attachment 6 Reminder Postcard-Patient.doc Supplementary Document Uploaded 2007-10-03 Available
Attachment 7 Training Curriculum Summary.doc Supplementary Document Uploaded 2007-10-03 Available
Attachment 5 Patient Intervention Materials Cover Letters.doc Supplementary Document Uploaded 2007-10-03 Available
IC Document Collections
IC IDCollectionTypeStatusForm
182546 Evaluation of an Intervention to Increase Colorectal Cancer Screening in Primary Care Clinice - Pre and Post Intervention Instruction Modified
182545 Evaluation of an Intervention to Increase Colorectal Cancer Screenig in Primary Care Clinics - Clincians Instruction Modified
182544 Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics-Clinic Support Staff Instruction Modified
182543 Intervention to Increase Colorectal Cancer Screening-Post Intervention Instruction Modified
182542 Evaluation of an Intervention to Increase Cancer Screening in Primary Clinics-Pre Intervention Only Instruction Modified
ICR Details
0920-0769 200909-0920-004
Historical Inactive 200904-0920-012
HHS/CDC
Evaluation of an Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics
No material or nonsubstantive change to a currently approved collection   No
Regular
Improperly submitted and continue 10/13/2009
Retrieve Notice of Action (NOA) 09/11/2009
Supporting statements (A and B) must be submitted with the package.
  Inventory as of this Action Requested Previously Approved
03/31/2011 03/31/2011 03/31/2011
6,894 0 6,894
2,332 0 2,332
0 0 0
This is a request for non-substantive changes to post-intervention surveys and letters. There is no change in burden.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
No
No
No
$791,402
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
No
Uncollected
Maryam Daneshvar 4046394604
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/11/2009