Pilot Study of African American Women on Health Care Attitudes and Behaviors

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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
6488	Pilot Study of African American Women on Health Care Attitudes and Behaviors		Migrated

ICR Details

OMB Control No: 0915-0243	ICR Reference No: 200002-0915-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Pilot Study of African American Women on Health Care Attitudes and Behaviors
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: 04/21/2000
	Date Received in OIRA: 02/22/2000
Terms of Clearance: OMB approves this information collection contingent upon the agency's ability to address the following issues: Considering the difficulty in separating the many confounding factors impacting entrance into sororities from that of education, how does the department intend to deal with this issue? What alternative databases has the department considered? Will the regional bias of this sample limit the pilot's practical utility? Does HRSA anticipate fielding other pilots in the future? Has the agency modeled these questions from previous surveys? Furthermore, the agency must give a more detailed justification for remuneration, discuss the difference it will make in the response rate, explain why remuneration is determined to be necessary for both samples, and explore alternatives capable of achieving comparable response rates. Prior to piloting this survey (and no later than 5/5/2000), OMB requests that the agency address these issues in writing. Based upon HRSA's response, OMB may request changes to the sampling methodology or survey instrument.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2001	03/31/2001
Responses	240	0	0
Time Burden (Hours)	120	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This purpose of this Pilot Study is to assess the feasibility of sampling strategies, data collection procedures, and the questionnaire instrument for a planned national study that will examine the health care experiences and attitudes of African American women.

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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
Pilot Study of African American Women on Health Care Attitudes and Behaviors

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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	240	0	0	240	0	0
Annual Time Burden (Hours)	120	0	0	120	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? Yes Part B of Supporting Statement

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: 02/22/2000

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