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 200910-0920-011 · OMB 0920-0769 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Evaluation of an Intervention to Increase Colorectal Cancer Screenig in Primary Care Clinics - Clincians Form Modified Available
Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics-Clinic Support Staff Form Modified Available
Intervention to Increase Colorectal Cancer Screening-Post Intervention Form Modified Repair queued
Supporting_Statement_B[1].doc Supporting Statement B Uploaded 2009-10-14 Available
Attachment_6_Changes_Reminder_Postcard_Clinicians.doc Supplementary Document Uploaded 2009-10-14 Repair queued
Attachment_6_Changes_Reminder_Postcard_Clinic_Staff.doc Supplementary Document Uploaded 2009-10-14 Available
Attachment_5_Changes_Post_Clinician_Survey_Cover_Letter.doc Supplementary Document Uploaded 2009-10-14 Available
Attachment_5_Changes_Post_Clinic_Support_Staff_Cover_Letter.doc Supplementary Document Uploaded 2009-10-14 Available
Attachment_5_Changes_Post_Patient_Survey_Cover_letter.doc Supplementary Document Uploaded 2009-10-14 Available
Attachment_4d_Changes_Clinician_Post-Intervention_Survey.doc Supplementary Document Uploaded 2009-10-14 Available
Attachment_4c_Changes_Clinic_Support_Staff_Post-Intervention_Survey.doc Supplementary Document Uploaded 2009-10-14 Repair queued
Attachment_4b_Changes_Patient_Post-Intervention_Survey.doc Supplementary Document Uploaded 2009-10-14 Available
0920-0769_OMB_Table of Proposed Changes.doc Supplementary Document Uploaded 2009-10-14 Available
0920-0769_OMB_Change_Request_2.doc Justification for No Material/Nonsubstantive Change Uploaded 2009-10-14 Available
Attachment 4b Patient Post-Intervention Survey.doc Supplementary Document Uploaded 2007-10-03 Available
Attachment_6_Revised_Reminder_Postcard_Clinicians.doc Supplementary Document Uploaded 2009-10-15 Available
Attachment_5_Revised_Post_Clinician_Survey_Cover_Letter.doc Supplementary Document Uploaded 2009-10-15 Repair queued
Attachment_6_Revised_Reminder_Postcard_Clinic_Staff.doc Supplementary Document Uploaded 2009-10-15 Available
Attachment_5_Revised_Post_Clinic_Support_Staff_Cover_Letter.doc Supplementary Document Uploaded 2009-10-15 Repair queued
Attachment_5_Revised_Post_Patient_Survey_Cover_letter.doc Supplementary Document Uploaded 2009-10-15 Available
OMB_CRC Intervention Study_11-16-05_Patient Intervention.pdf Supplementary Document Uploaded 2007-10-03 Repair queued
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 Repair queued
Supporting_Statement_A[1].doc Supporting Statement A Uploaded 2009-10-14 Repair queued
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 Form Modified
182544 Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics-Clinic Support Staff Form Modified
182543 Intervention to Increase Colorectal Cancer Screening-Post Intervention Form Modified
182542 Evaluation of an Intervention to Increase Cancer Screening in Primary Clinics-Pre Intervention Only Instruction Modified
ICR Details
0920-0769 200910-0920-011
Historical Active 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
Approved without change 11/02/2009
Retrieve Notice of Action (NOA) 10/26/2009
  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 a nonsubstantive change with no change in burden.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  71 FR 52334 09/05/2006
72 FR 51823 09/11/2007
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 6,894 6,894 0 0 0 0
Annual Time Burden (Hours) 2,332 2,332 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
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.
10/26/2009