OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Impact Evaluation of CDC's Colorectal Cancer Control Program

ICR 201308-0920-003 · OMB 0920-0992 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Interview with Grantee State and Local Partners Form New Repair queued
Interview with Nongrantee State and Local Partners Form New Available
Interview with Non-grantee Evaluators Form New Available
Interview with Non-grantee Program Staff Form New Available
Interview Guide for Non-Grantee Private Sector Partners Form New Available
Interview Guide for Grantee Private Sector Partners Form New Repair queued
Interview Guide for Grantee Evaluators Form New Available
Interview Guide for Grantee Program Staff Form New Available
Site Visit Instructions Template Form New Repair queued
Suggested Interviewees Form Form New Available
Screening Practices: Survey of Primary Care Providers Form New Available
Colorectal Cancer Population Survey Form New Repair queued
Screener for Population Survey Form New Available
SS Part B_07 18 2013.doc Supporting Statement B Uploaded 2013-07-22 Available
ATT 12 ICF Macro IRB Approval.docx Supplementary Document Uploaded 2013-07-22 Available
ATT 10 Observational Assessment Guide.docx Supplementary Document Uploaded 2013-07-22 Available
ATT 9 Document Review Form.docx Supplementary Document Uploaded 2013-07-22 Available
ATT 11 Non-disclosure Agreement for Data Collection Contractors 7.18.2013.docx Supplementary Document Uploaded 2013-07-22 Available
ATT 2B Summary of Public Comments and CDC Response.pdf Supplementary Document Uploaded 2013-07-22 Available
ATT 2A 60 Day Federal Register Notice.pdf Supplementary Document Uploaded 2013-07-22 Available
ATT 1 Authorizing Legislation, Section 301 Public Health Service Act.doc Supplementary Document Uploaded 2013-07-22 Repair queued
ATT 7D Informed Consent Form.docx Supplementary Document Uploaded 2013-07-31 Available
ATT 8D Informed Consent Form.docx Supplementary Document Uploaded 2013-07-22 Repair queued
ATT 8D Informed Consent Form.docx Supplementary Document Uploaded 2013-07-22 Repair queued
ATT 8D Informed Consent Form.docx Supplementary Document Uploaded 2013-07-31 Available
ATT 7D Informed Consent Form.docx Supplementary Document Uploaded 2013-07-22 Available
ATT 7D Informed Consent Form.docx Supplementary Document Uploaded 2013-07-22 Repair queued
ATT 7D Informed Consent Form.docx Supplementary Document Uploaded 2013-07-22 Available
ATT 6E Site Visit Confirmation Email.docx Supplementary Document Uploaded 2013-07-22 Available
ATT 6D Nongrantee Site Visit Introductory Letter Email.docx Supplementary Document Uploaded 2013-07-22 Available
ATT 6C Grantee Site Visit Introductory Letter Email.docx Supplementary Document Uploaded 2013-07-22 Available
ATT 5E Second Survey Mailing Cover Letter.docx Supplementary Document Uploaded 2013-07-22 Available
ATT 5D Reminder Fax for Provider Survey.docx Supplementary Document Uploaded 2013-07-22 Repair queued
ATT 5C Advance Fax for Provider Survey.docx Supplementary Document Uploaded 2013-07-22 Available
ATT 5B Provider Survey Invitation Cover Letter.docx Supplementary Document Uploaded 2013-07-22 Repair queued
ATT 4B Screen shots of the CATI Administration Population Survey.pdf Supplementary Document Uploaded 2013-07-29 Available
SS Part A_07 18 2013.docx Supporting Statement A Uploaded 2013-07-22 Available
IC Document Collections
IC IDCollectionTypeStatusForm
208038 Interview with Grantee State and Local Partners Form New
208037 Interview with Nongrantee State and Local Partners Form New
208036 Interview with Non-grantee Evaluators Form New
208035 Interview with Non-grantee Program Staff Form New
208034 Interview Guide for Non-Grantee Private Sector Partners Form New
208033 Interview Guide for Grantee Private Sector Partners Form New
208032 Interview Guide for Grantee Evaluators Form New
208031 Interview Guide for Grantee Program Staff Form New
208030 Site Visit Instructions Template Form New
208029 Suggested Interviewees Form Form New
208028 Screening Practices: Survey of Primary Care Providers Form New
208027 Colorectal Cancer Population Survey Form New
208026 Screener for Population Survey Form New
ICR Details
0920-0992 201308-0920-003
Historical Active
HHS/CDC 20097
Impact Evaluation of CDC's Colorectal Cancer Control Program
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/26/2013
Retrieve Notice of Action (NOA) 08/02/2013
  Inventory as of this Action Requested Previously Approved
09/30/2016 36 Months From Approved
14,456 0 0
2,425 0 0
0 0 0
CDC plans to conduct a study to examine whether CRCCP program activities increase state-level colorectal cancer screening rates and other proximal outcomes.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  77 FR 50696 08/22/2012
78 FR 45201 07/26/2013
Yes
  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 14,456 0 0 14,456 0 0
Annual Time Burden (Hours) 2,425 0 0 2,425 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$983,381
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]
  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.
08/02/2013