Formative Research on Lung Cancer

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment G2 Physician Informed Consent[2].doc	Supplementary Document	Uploaded 2009-01-08	Available
Attachment F Physician Response Form[2].doc	Supplementary Document	Uploaded 2009-01-08	Available
Attachment E In-Depth Interview Consumer[2].doc	Supplementary Document	Uploaded 2009-01-08	Available
Attachment D1 Consumer Informed Consent[2].doc	Supplementary Document	Uploaded 2009-01-08	Available
Attachment H IRB Approval 2008-2009.doc	Supplementary Document	Uploaded 2008-11-05	Available
Attachment G2 Physician Informed Consent.doc	Supplementary Document	Uploaded 2008-11-05	Available
Attachment G1 Provider Recruitment Materials.doc	Supplementary Document	Uploaded 2008-11-05	Available
Attachment D1 Consumer Informed Consent.doc	Supplementary Document	Uploaded 2008-11-05	Available
SS_Part_A_103008[2].doc	Supporting Statement A	Uploaded 2009-01-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
187254	Physician Focus Group	Other-WORD	New
187253	Physican Response Form	Other-WORD	New
187252	In-Dept Interviews with Health Care Consumers	Other-WORD	New
187251	Health Care Consumer Focus Groups	Other-WORD	New
187250	Health Care Consumer Screening	Other-WORD	New

ICR Details

OMB Control No: 0920-0801	ICR Reference No: 200811-0920-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Formative Research on Lung 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: 01/09/2009
	Date Received in OIRA: 11/17/2008
Terms of Clearance: This ICR is approved consistent with the uploads and memo received 01/08/09.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	24 Months From Approved
Responses	360	0	0
Time Burden (Hours)	193	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC plans to conduct a study to address gaps in knowledge about attitudes, experiences, and practices related to lung cancer screening and testing. Information will be collected from focus group discussions and in-depth interviews with health care consumers. Information will also be collected from focus groups with primary care physicians.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act - Research and Investigation
  

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:
	72 FR 45429	08/04/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 66247	11/07/2008
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Health Care Consumer Screening
Health Care Consumer Focus Groups
In-Dept Interviews with Health Care Consumers
Physican Response Form
Physician Focus Group

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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	360	0	0	360	0	0
Annual Time Burden (Hours)	193	0	0	193	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.

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Annual Cost to Federal Government: $104,433

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: 11/17/2008

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