Information Collection

Cost Assessment Tool

IC 179138 under ICR 201004-0920-014 · OMB 0920-0745.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0745 can be found here:

Documents and Forms

Document Name Document Type
Form 2 Cost Assessment Tool Form and Instruction
2 Colorectal Cancer Control Program Cost Assessment Tool-- Attachment 5a Cost Assessment Tool.xls Form and Instruction
Attachment 5b Cost Assessment Tool Users Manual.doc Attachment 5b Cost Assessment Tool Users Manual IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cost Assessment Tool	Agency IC Tracking Number:

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 and Instruction	2	Colorectal Cancer Control Program Cost Assessment Tool--User's Guide	Attachment 5a Cost Assessment Tool.xls		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	26	21	5
Annual IC Time Burden (Hours)	572	567	5
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 5b Cost Assessment Tool Users Manual	Attachment 5b Cost Assessment Tool Users Manual.doc	04/08/2010

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