generic_clearance_form 31710

SUBMISSION OF INFORMATION COLLECTION

UNDER GENERIC CLEARANCES

DATE OF REQUEST: _March 17, 2010

SUB AGENCY (I/C): ___NCCAM____________

TITLE: ___NCCAM Health Professional Portal ________________

GENERIC CLEARANCE UNDER OMB# ­_0925-0530___ EXP. DATE: _10/31/2010_____

ABSTRACT:

The NCCAM health professional portal page is a fundamental tool for providing complementary and alternative medical information to health care providers. A survey distributed to attendees of physician-focused meetings where NCCAM will be exhibiting would provide the necessary feedback to create the types of tools and content for the health professional portal page that is needed by this audience. The responses would allow NCCAM to gauge what topics and tools the health care providers are most interested in, construct optimal formats, and determine preferred delivery methods.

We will recruit up to 100 respondents at the American Pain Society 29^th Annual Scientific Meeting, 2010 American Geriatric Society Annual Scientific Meeting, and the 2010 National Medical Association Annual Convention and Scientific Assembly The survey will be administered as a self-administered questionnaire at the NCCAM exhibit booth. No technology will be used to complete the survey. Completion will be voluntary with no payment and individual responses will be kept confidential. Findings will be used by NCCAM for program planning purposes and published or otherwise shared externally.

TOTAL ANNUAL BURDEN APPROVED: _712_________

BURDEN USED TO DATE: ___80_______

BURDEN THIS REQUEST: ___15______

IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED?

______YES ___x___NO______N/A

OBLIGATION TO RESPOND:

__x____ VOLUNTARY

______ REQUIRED TO OBTAIN OR RETAIN BENEFITS

______ MANDATORY

HOW WILL THIS SURVEY BE OFFERED?

_____ WEB SITE

_____ TELEPHONE INTERVIEW

_____ MAIL RESPONSE

____ IN PERSON INTERVIEW

__X___ OTHER: self-administered questionnaire_

CONTACT INFORMATION:

NAME: __ Alyssa Cotler _________________________________________

TELEPHONE NUMBER: _301-451-3851___________________________

EMAIL ADDRESS: _ [email protected] ________________________