Assessing Problem Areas in Referrals for Chronic Hematologic Malignancies and Developing Interventions to Address Them

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Att 6A_08AU_ Informed Consent Patients.pdf	Supplementary Document	Uploaded 2009-12-29	Available
Att 4A_08AU_ Informed Consent Physicians.pdf	Supplementary Document	Uploaded 2009-12-29	Available
Att 14A_08AU_Informed Consent Physician Focus Group.doc	Supplementary Document	Uploaded 2009-12-29	Repair queued
08AU_Supporting Statement B_092309.doc	Supporting Statement B	Uploaded 2009-10-01	Available
Att 17_Overall Study Plan with Publications 092309.xls	Supplementary Document	Uploaded 2009-10-01	Available
Att 16_description of CDC funded Hematology Projects 092309.pdf	Supplementary Document	Uploaded 2009-10-01	Available
Att 15_IRB Approval Letters 092309.doc	Supplementary Document	Uploaded 2009-10-01	Available
Att 2b_Summary of Public Comments 092309.doc	Supplementary Document	Uploaded 2009-10-01	Repair queued
Att 2_Published 60d FRN_092309.pdf	Supplementary Document	Uploaded 2009-10-01	Available
Att 1_Section 301 of the Public Health Service Act.doc	Supplementary Document	Uploaded 2009-10-07	Available
08AU_SS_A_Revised 12.09.09.doc	Supporting Statement A	Uploaded 2009-12-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
191097	Primary care Providers Focus Group Guide	Other-WORD	New
191096	Primary Care Provider Focus Group Phone Recruitment Script	Other-WORD	New
191095	Primary Care Provider Interview Guide	Other-WORD	New
191094	Primary Care Provider Interview Phone Recruitment Script	Other-WORD	New
191093	Primary Care Provider Reminder Letter	Other-WORD	New
191092	Primary Care Provider Opt-Out Card	Other-WORD	New
191091	Primary Care Provider Survey	Other-WORD	New
191090	Primary Care Provider Survey Cover Letter	Other-WORD	New
191089	Patient Interview Guide	Other-WORD	New
191088	Patient Interveiw Phone Recruitment Script	Other-WORD	New
191087	Community Oncologists and Hematologists Interviews Guide	Other-W(RD	New
191086	Community Oncologists and Hematologists Interview Phone Recruitment Script	Other-WORD	New

ICR Details

OMB Control No: 0920-0836	ICR Reference No: 200910-0920-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Assessing Problem Areas in Referrals for Chronic Hematologic Malignancies and Developing Interventions to Address Them
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: 12/31/2009
	Date Received in OIRA: 10/23/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2010	12 Months From Approved
Responses	1,072	0	0
Time Burden (Hours)	198	0	0
Cost Burden (Dollars)	13,837	0	0

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Abstract: CDC proposes to collect information from Primary Care Providers, community oncologists, community hematologists, and patients about referral practices for patients with chronic hematological malignancies. Information will be used to develop a prototype intervention designed to facilitate timely care for patients with chronic hematologic disease.

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Authorizing Statute(s): US Code: 42 USC 241 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 16873	04/13/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 50800	10/01/2009
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 12

table that charts list of burden

IC Title	Form No.	Form Name
Community Oncologists and Hematologists Interview Phone Recruitment Script
Community Oncologists and Hematologists Interviews Guide
Patient Interveiw Phone Recruitment Script
Patient Interview Guide
Primary Care Provider Survey Cover Letter
Primary Care Provider Survey
Primary Care Provider Opt-Out Card
Primary Care Provider Reminder Letter
Primary Care Provider Interview Guide
Primary Care Provider Interview Phone Recruitment Script
Primary Care Provider Focus Group Phone Recruitment Script
Primary care Providers Focus Group Guide

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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	1,072	0	0	1,072	0	0
Annual Time Burden (Hours)	198	0	0	198	0	0
Annual Cost Burden (Dollars)	13,837	0	0	13,837	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: CDC proposed to conduct a new, one-time information collection involving primary care providers, community oncologists and hematologists, and patients with chronic hematologic malignancies. Information will be used to develop a prototype intervention to facilitate appropriate medical care for patients and timely referral from primary care providers to cancer specialists. The information needed to develop appropriate, targeted intervention is not available from other sources.

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Annual Cost to Federal Government: $452,500

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: 10/23/2009

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