A Study of Primary and Secondary Prevention Behaviors Practiced Among Five-Year Survivors of Colorectal Cancer

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CATI Option for Survey of Health Behaviors	Form	New	Available
Survey of Health Behaviors for Five-Year Survivors of Colorectal Cancer	Form	New	Available
Physician Permission to Contact Potential Survey Respondents	Form	New	Available
SS Part B.doc	Supporting Statement B	Uploaded 2009-04-01	Available
Attachment H_CDC IRB APPROVAL.doc	Supplementary Document	Uploaded 2009-04-01	Available
Attachment G_Non-disclosure Agreement.pdf	Supplementary Document	Uploaded 2009-04-01	Available
Attachment C_Technical supplement.doc	Supplementary Document	Uploaded 2009-04-01	Available
Attachment B_60-day FRN.pdf	Supplementary Document	Uploaded 2009-04-01	Available
Attachment B2_Summary of Public Comments.doc	Supplementary Document	Uploaded 2009-04-01	Available
Attachment A_ Authorizing Legislation.doc	Supplementary Document	Uploaded 2009-04-01	Available
Attachment E6_COVER LETTER FOR FOLLOWUP.doc	Supplementary Document	Uploaded 2009-04-01	Available
Attachment E5_REMINDER POSTCARD.doc	Supplementary Document	Uploaded 2009-04-01	Available
Attachment E4_PARTICIPANT CONSENT FORM.doc	Supplementary Document	Uploaded 2009-04-01	Available
Attachment E3_COVER LETTER FOR SURVEY PACKET.doc	Supplementary Document	Uploaded 2009-04-01	Available
Attachment E2_CCR Brochure.pdf	Supplementary Document	Uploaded 2009-04-01	Available
Attachment E1_ADVANCE LETTER FOR RESPONDENTS.doc	Supplementary Document	Uploaded 2009-04-01	Available
Attachment D2_COVER LETTER FOR PHYSICIANS.doc	Supplementary Document	Uploaded 2009-04-01	Available
SS Part A.docm	Supporting Statement A	Uploaded 2009-04-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
188832	CATI Option for Survey of Health Behaviors	Form	New
188831	Survey of Health Behaviors for Five-Year Survivors of Colorectal Cancer	Form	New
188830	Physician Permission to Contact Potential Survey Respondents	Form	New

ICR Details

OMB Control No: 0920-0815	ICR Reference No: 200904-0920-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: A Study of Primary and Secondary Prevention Behaviors Practiced Among Five-Year Survivors of Colorectal 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 without change	Conclusion Date: 06/24/2009
	Date Received in OIRA: 04/17/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2010	12 Months From Approved
Responses	3,050	0	0
Time Burden (Hours)	1,095	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in the U.S. There are currently over one million CRC survivors in the U.S. and this number is growing. CDC plans to conduct a study of 5-year survivors to examine adherence to recommended screening and prevention practices in this population, and to identify facilitators and barriers.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Pulbic 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:
	73 FR 44268	07/30/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 15728	04/07/2009
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

IC Title	Form No.	Form Name
Physician Permission to Contact Potential Survey Respondents	none	Permission to Contact Potential Participants
Survey of Health Behaviors for Five-Year Survivors of Colorectal Cancer	none	Survey of Health Behaviors
CATI Option for Survey of Health Behaviors	none	CATI Option for Survey of Health 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	3,050	0	0	3,050	0	0
Annual Time Burden (Hours)	1,095	0	0	1,095	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 ICR.

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Annual Cost to Federal Government: $274,890

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? Yes

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)? No

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: 04/17/2009

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