Collection of Customer Service, Demographic and Smoking/Tobacco Use Information from NCI Cancer Information Service (CIS) Clients

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 CIS Telephone Clients - Customer Service Questions	Form	Modified	Available
Form 5 CIS Smoking Cessation Proactive Callback Follow-ups	Form	New	Available
Form 4 CIS Smoking Cessation Reactive Service Clients "Demographic" Questions	Form	New	Available
Form 4 CIS Smoking Cessation Reactive Service Client "Intake" Questions	Form	New	Source copy available
Form 3 CIS LiveHelp Questionnaire	Form	New	Available
Form 2 CIS Telephone Clients - Demographic Questions	Form	New	Available
SSB_CIS_6-26-09.doc	Supporting Statement B	Uploaded 2009-06-26	Available
CIS_Cover_Memo_6-25-09.doc	Supplementary Document	Uploaded 2009-06-26	Available
Appendix 8 Data Analysis Plan.doc	Supplementary Document	Uploaded 2009-06-25	Available
Appendix 7 CIS 2008 Annual Statistics 032409.pdf	Supplementary Document	Uploaded 2009-06-12	Available
Appendix 6 Confidentiality of CIS Communications.doc	Supplementary Document	Uploaded 2009-06-12	Available
Appendix 5 OHSR Clearance.pdf	Supplementary Document	Uploaded 2009-06-12	Available
Appendix 4 Privacy Act Memo.doc	Supplementary Document	Uploaded 2009-06-12	Available
Appendix 3 Use of Data TOC Journal of Cancer Ed.docx	Supplementary Document	Uploaded 2009-06-12	Available
Appendix 1 CIS Contact Centers.doc	Supplementary Document	Uploaded 2009-06-12	Available
SSA_CIS_6-26-09.doc	Supporting Statement A	Uploaded 2009-06-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43626	CIS Telephone Clients - Customer Service Questions	Form	Modified
189806	CIS Smoking Cessation Proactive Callback Follow-ups	Form	New
189805	CIS Smoking Cessation Reactive Service Clients "Demographic" Questions	Form	New
189804	CIS Smoking Cessation Reactive Service Client "Intake" Questions	Form	New
189803	CIS LiveHelp Questionnaire	Form	New
189802	CIS Telephone Clients - Demographic Questions	Form	New

ICR Details

OMB Control No: 0925-0208	ICR Reference No: 200907-0925-001
Status: Historical Active	Previous ICR Reference No: 200607-0925-004
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Collection of Customer Service, Demographic and Smoking/Tobacco Use Information from NCI Cancer Information Service (CIS) Clients
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/27/2009
	Date Received in OIRA: 07/02/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2012	36 Months From Approved	09/30/2009
Responses	100,667	0	49,400
Time Burden (Hours)	2,492	0	1,823
Cost Burden (Dollars)	0	0	0

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Abstract: The National Cancer Institute (NCI) currently collects: 1) customer service and demographic information from clients of the Cancer Information Service (CIS) in order to properly plan, implement, and evaluate cancer education efforts, including assessing the extent by which the CIS reaches and impacts underserved populations; 2) smoking/tobacco use behavior of individuals seeking CIS's smoking cessation assistance in order to provide smoking cessation services tailored to the individual client's needs and track their smoking behavior at follow up. The purpose of this request is to renew NCI'S previously approved requests to conduct the above-stated information collections (OMB No. 0925-0208).

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Authorizing Statute(s): US Code: 42 USC 412 (285a-1) 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:
	74 FR 20320	05/01/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 31445	07/01/2009
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
CIS Smoking Cessation Reactive Service Clients "Demographic" Questions	4	Smoking Cessation Reactive Service Client Questions
CIS Smoking Cessation Proactive Callback Follow-ups	5	Smoking Cessation Proactive Follow-Up
CIS Telephone Clients - Customer Service Questions	1	Telephone Client-Customer Service Questions
CIS Telephone Clients - Demographic Questions	2	Telephone Clients - Demographic Questions
CIS LiveHelp Questionnaire	3	LiveHelp Questionnaire
CIS Smoking Cessation Reactive Service Client "Intake" Questions	4	Smoking Cessation Reactive Service Client Questions

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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	100,667	49,400	0	0	51,267	0
Annual Time Burden (Hours)	2,492	1,823	0	0	669	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

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: $99,864

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)? 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: 07/02/2009

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