Increasing Cervical Cancer Screening in Never or Rarely Screened Black Women: Phase I

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
7146	Increasing Cervical Cancer Screening in Never or Rarely Screened Black Women: Phase I	Migrated

ICR Details

OMB Control No: 0920-0678	ICR Reference No: 200411-0920-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Increasing Cervical Cancer Screening in Never or Rarely Screened Black Women: Phase I
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 with change	Conclusion Date: 04/28/2005
	Date Received in OIRA: 11/30/2004
Terms of Clearance: Approved consistent with the following terms of clearance (see CDC memo submitted to OMB 05/25/05): the agency will not report the results of the study as generalizable or representative of the respondent population, CDC will amend its proposed incentive structure as outline in the 05/25 memo, the proposed study will not provide validation for the health literacy materials that will be used. Upon completion of the information collection CDC will provide a report to OMB on the results of the proposed study.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2006	11/30/2006
Responses	630	0	0
Time Burden (Hours)	158	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This project seeks to collect information through focus groups about the experiences, beliefs, feelings, and perceptions regarding cervical cancer and the Pap test of black women 50-64 years old who have never received a Pap test or who have not had one in 4 or more years. Additionally, an assessment of the health literacy level of these women will be made using a validated instrument, the short-Test of Functional Health Literacy for Adults. Women will live in Hattiesburg, MS, Bradenton, FL, Monroe, LA, or Rock Hill, SC, and be uninsured. The information from this first phase of a...

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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

IC Title	Form No.	Form Name
Increasing Cervical Cancer Screening in Never or Rarely Screened Black Women: Phase I

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ICR Summary 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	630	0	0	630	0	0
Annual Time Burden (Hours)	158	0	0	158	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: 11/30/2004

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