OMB control number

[NCCDPHP] National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Monitoring Activities

OMB 0920-1046 · HHS/CDC.

OMB 0920-1046

This project will systematically collect information about implementation, including delivery of screening and follow-up clinical services, and outcomes of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which funds 71 recipients. In this Revision, CDC proposed use of three revised instruments - the annual NBCCEDP survey, clinic-level data collection, and quarterly program update (QPU) - and continued use of two instruments - the Service Delivery Projection Worksheet and MDEs - with no changes. The estimated burden will decrease from 1,220 to 1,162.

The latest form for [NCCDPHP] National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Monitoring Activities expires 2028-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-1046 Minimum Data Elements (MDE) Data Definition Table Form and Instruction
Form 0920-1046 NBCCEDP Service Delivery Projection Worksheet Form and Instruction
Form 0920-1046 NBCCEDP Quarterly Program Update Form and Instruction
Form 0920-1046 NBCCEDP Clinic-Level Data Instrument (Cervical) Form and Instruction
Form 0920-1046 NBCCEDP Clinic-Level Data Collection Instruments Form and Instruction
Form 0920-1046 Annual NBCCEDP Survey Form and Instruction
0920-1046_PIA final.pdf Supplementary Document
Att 11 - 60 Day Federal Register Notice.pdf Supplementary Document
Att 10 - Institutional Review Board Approval.pdf Supplementary Document
Att 7d - NBCCEDP Quarterly Program Update Reminder Email.docx Supplementary Document
Att 7c - NBCCEDP Quarterly Program Update Administration Email.docx Supplementary Document
Att 7b - NBCCEDP Quarterly Program Update Pre-Administration Email.docx Supplementary Document
Att 6c - NBCCEDP Clinic-Level Data Collection Reminder Email.docx Supplementary Document
Att 6b - NBCCEDP Clinic-Level Data Collection Introductory Email.docx Supplementary Document
Att 5c - Annual NBCCEDP Survey Reminder Email_v2.docx Supplementary Document
Att 5b - Annual NBCCEDP Survey Introductory Email_v2.docx Supplementary Document
Att 4 - NBCCEDP Data Collection Revision Matrix.docx Supplementary Document
Att 3 - DP22-2202 NBCCEDP Logic Model.pdf Supplementary Document
Att 2 - Breast and Cervical Cancer Mortality Prevention Act of 1990.pdf Supplementary Document
Att 1 - Authorizing Legislation.pdf Supplementary Document
0920-1046 SS Part B_Revision.docx Supporting Statement B
0920-1046 SS Part A Revision_rev_final.docx Supporting Statement A
Minimum Data Elements (MDE) Data Definition Table Form and Instruction
NBCCEDP Service Delivery Projection Worksheet Form and Instruction
NBCCEDP Quarterly Program Update Form and Instruction
NBCCEDP Clinic-Level Data Instrument (Cervical) Form and Instruction
NBCCEDP Clinic-Level Data Collection Instruments Form and Instruction
Annual NBCCEDP Survey Form and Instruction

All Historical Document Collections

202501-0920-002	Revision of a currently approved collection	2025-01-13
202111-0920-005 Approved without change	Revision of a currently approved collection	2021-11-18
202009-0920-022 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-09-28
201805-0920-008 Approved without change	Reinstatement with change of a previously approved collection	2018-10-31
201410-0920-018 Approved without change	New collection (Request for a new OMB Control Number)	2014-10-27

OMB Details

Annual NBCCEDP Survey

Federal Enterprise Architecture: Health - Consumer Health and Safety

Form 0920-1046

Annual National Breast and Cervical Early Detection Program (NBCCEDP) Survey

Fillable Fileable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.