Risk Perception, Worry, and Use of Ovarian Cancer Screening among Women at High, Elevated, and Average Risk of Ovarian Cancer

Forms and Documents

Document Name	Status
Follow-up Questionnaire Form and Instruction	New
Telephone Screener (pages E1-E4 of the Baseline Questionnaire Form) Form and Instruction	New
Baseline Questionnaire (pages E5-E27 of the Baseline Questionnaire Form) Form and Instruction	New
OMB Response 7_12_07.doc Supplementary Document	2007-07-24
Supporting Statement part B 4-3-2007.doc Supporting Statement B	0000-00-00
ATTACHMENT B.60day notice.doc Supplementary Document	0000-00-00
ATTACHMENT D. Henry Ford IRB approval.doc Supplementary Document	0000-00-00
ATTACHMENT C.IRB approval.doc Supplementary Document	0000-00-00
Supporting Statement part A 4-3-2007.doc Supporting Statement A	0000-00-00

IC Document Collections

IC ID	Document Title	Status
179711	Follow-up Questionnaire Form and Instruction	New
179710	Telephone Screener (pages E1-E4 of the Baseline Questionnaire Form) Form and Instruction	New
179709	Baseline Questionnaire (pages E5-E27 of the Baseline Questionnaire Form) Form and Instruction	New

ICR Details

OMB Control No: 0920-0744	ICR Reference No: 200704-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Risk Perception, Worry, and Use of Ovarian Cancer Screening among Women at High, Elevated, and Average Risk of Ovarian Cancer
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: 07/25/2007
	Date Received in OIRA: 04/19/2007
Terms of Clearance: Approved consistent with CDC response to OMB questions and comments.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2010	36 Months From Approved
Responses	11,867	0	0
Time Burden (Hours)	1,411	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: A baseline survey will be administered through a computer-assisted telephone interview (CATI) program to 2,000 women affiliated with Henry Ford Health Systems in Detroit, MI. Women will be asked a series of questions over a 35-minute (.58 hour) time period. Questions will cover key variables related to ovarian cancer screening including coping, anxiety, perceived risk, worry, family cancer history, closeness to family member of friend who has had cancer, and screening behavior. A shortened follow-up survey will be administered to approximately 1,600 of the women included at baseline (15% attrition).

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 15187	03/27/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 17553	04/09/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Baseline Questionnaire (pages E5-E27 of the Baseline Questionnaire Form)	None	Baseline Questionnaire
Telephone Screener (pages E1-E4 of the Baseline Questionnaire Form)	None	Baseline Questionnaire
Follow-up Questionnaire	None	Follow-up Questionnaire

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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	11,867	0	0	11,867	0	0
Annual Time Burden (Hours)	1,411	0	0	1,411	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new data collection activity designed to examine the perception of risk for ovarian cancer and its relationship to screening behavior.

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Annual Cost to Federal Government: $315,155

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: 04/19/2007

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