Clinical Data Elements (CCDE)

Colorectal Cancer Screening Program

Documents and Forms

Document Name Document Type
Attachment 3b. CCDE Data Definition Table.docx Other-Data Definition Table
Attachment 3a. CCDE Submission Web portal.doc Other-Entry to Web Portal Screenshot
Attachment 3c. CCDE Data Users Manual.docx Data Users Manual IC Document

Information Collection (IC) Details

IC Title:	Clinical Data Elements (CCDE)	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
Other-Data Definition Table			Attachment 3b. CCDE Data Definition Table.docx		Yes	Yes	Fillable Fileable
Other-Entry to Web Portal Screenshot			Attachment 3a. CCDE Submission Web portal.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 29	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10,875	1,125	9,750
Annual IC Time Burden (Hours)	2,719	281	2,438
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Data Users Manual	Attachment 3c. CCDE Data Users Manual.docx	03/14/2013

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