PHYSICIAN-BASED ASSESSMENT AND COUNSELING FOR EXERCISE (PACE): A PILOT STUDY

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Forms and supporting documents for this ICR

Document	Type	Status	Availability

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IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
111037	PHYSICIAN-BASED ASSESSMENT AND COUNSELING FOR EXERCISE (PACE): A PILOT STUDY		Migrated

ICR Details

OMB Control No: 0920-0303	ICR Reference No: 199204-0920-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: PHYSICIAN-BASED ASSESSMENT AND COUNSELING FOR EXERCISE (PACE): A PILOT STUDY
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/17/1992
	Date Received in OIRA: 04/20/1992
Terms of Clearance: This information collection is approved through 12/92 with the followi conditions: 1) CDC shall conduct a study subsequent to the proposed "pilot" study to test the new training materials and protocols (refined as a result of the data collected in the proposed study) against the original training and protocols. 2) Because the purpose of the proposed study is to "gather information about provider acceptability and usability of the PACE training materi and provider, office staff, and patient acceptability of the counselin protocols", CDC shall eliminate the following questions that do not re flect this purpose: **REMARKS CONTINUED**

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/1992	12/31/1992
Responses	960	0	0
Time Burden (Hours)	552	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THE DATA COLLECTIONS WILL INCLUDE THE PHYSICIAN'S PERSONAL PHYSICAL ACTIVITY HABITS, CURRENT HEALTH PROMOTION ACTIVITIES, AND ACTIVITY COUNSELING PRACTICES. RESPONDENTS INFORMATION WILL BE FROM OFFICE STA OF THE PHYSICIANS AND TELEPHONE SURVEYS OF RANDOMLY SELECTED PATIENTS THAT WERE SEEN BY THE PHYSICIAN DURING THE 6-MONTH PILOT. THE INFORMATION WILL BE USED TO EVALUATE THE PHYSICIAN ASSESSMENT AND

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
PHYSICIAN-BASED ASSESSMENT AND COUNSELING FOR EXERCISE (PACE): A PILOT STUDY

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ICR Summary of Burden

table that charts list of burden

	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	960	0	0	960	0	0
Annual Time Burden (Hours)	552	0	0	552	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/20/1992

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