Information Collection Request

Questionnaire Cognitive Interviewing and Pretesting (NCI)

ICR 201008-0925-003 · OMB 0925-0589 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Pilot Test Questionnaire and Debriefing Questionnaire Form and Instruction New Available
Form 1 HINTS 4 Attachment A, B, & E Form and Instruction New Available
Form 2 #7_REV_Justif Memo Attach 7B 7D and 7F_MDC Form and Instruction New Available
Form 1 #6_REV_Justif Memo and Attach 6B 6C 6E 6F 6G_HINTS Form and Instruction New Available
Form 1 #6_REV_Attach 6A 6D Screen and Guide Form and Instruction New Available
Form 1 #6_Attach 6A & 6D Screen and Guide Form and Instruction New Available
Form 2 #7_Attach 7A 7C and 7E_MDC Cog Interview Form and Instruction New Available
Form 3 #8_Attach 8A, 8E, 8F, & 8G_Email, Guide & Qx_NExT Form and Instruction New Available
Form 3 #5 Attachments C2, C3, C4 & C5 Form and Instruction Unchanged Available
Form 2 #4 Attachments B2, B5, B6 & B7 Form and Instruction Unchanged Available
Form 1 #3 Attachments A1 and A4 Form and Instruction Unchanged Available
Form 1 Survey to Evaluate Changes to Website Design Form Unchanged Available
Form 1 Screener & Survey Sub-Study #1 Form Unchanged Available
Change Request to burden.doc Justification for No Material/Nonsubstantive Change Uploaded 2010-08-23 Available
SSB_10-31-07.doc Supporting Statement B Uploaded 2007-12-07 Available
ATTACHMENT L Detailed explanation to participants.doc Supplementary Document Uploaded 2007-12-07 Available
ATTACHMENT K Participant data sheet.doc Supplementary Document Uploaded 2007-12-07 Available
ATTACHMENT J Sample script for answering machine.doc Supplementary Document Uploaded 2007-12-07 Available
ATTACHMENT I Sample Screening script.doc Supplementary Document Uploaded 2007-12-07 Repair queued
ATTACHMENT H Newspaper script.doc Supplementary Document Uploaded 2007-12-07 Available
ATTACHMENT G OHSR Exemption approval.doc Supplementary Document Uploaded 2007-12-07 Available
ATTACHMENT F Consent to show recording.doc Supplementary Document Uploaded 2007-12-07 Available
ATTACHMENT E-2 Consent Groups.doc Supplementary Document Uploaded 2007-12-07 Available
ATTACHMENT E-1 Consent Interview.doc Supplementary Document Uploaded 2007-12-07 Available
ATTACHMENT D Letter from Privacy Act Officer.pdf Supplementary Document Uploaded 2007-12-07 Available
ATTACHMENT C HINTS 2005 Advance-letter.doc Supplementary Document Uploaded 2007-12-07 Available
ATTACHMENT B-2 Sample Qx Cancer Quality of Life.doc Supplementary Document Uploaded 2007-12-07 Available
ATTACHMENT B-1 Sample Qx TUS Population Survey.doc Supplementary Document Uploaded 2007-12-07 Available
ATTACHMENT A Cognitive Interviewing.doc Supplementary Document Uploaded 2007-12-07 Available
Cover Letter.doc Supplementary Document Uploaded 2007-12-07 Available
SSA_11-27-07.doc Supporting Statement A Uploaded 2007-12-07 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
196228 #10 Sub-study "Health Information National Trends Survey 4 (HINTS 4) Pilot Test " Form and Instruction NewPilot Test Questionnaire and Debriefing Questionnaire
195979 #9 Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of Cycle 1 Instrument Form and Instruction NewHINTS 4 Attachment A, B, & E
195663 #6, #7, and #8 Bundled Sub-studies for HINTS, MDC and NExT Form and Instruction New#7_REV_Justif Memo Attach 7B 7D and 7F_MDC
195663 #6, #7, and #8 Bundled Sub-studies for HINTS, MDC and NExT Form and Instruction New#6_REV_Justif Memo and Attach 6B 6C 6E 6F 6G_HINTS
195663 #6, #7, and #8 Bundled Sub-studies for HINTS, MDC and NExT Form and Instruction New#6_REV_Attach 6A 6D Screen and Guide
195663 #6, #7, and #8 Bundled Sub-studies for HINTS, MDC and NExT Form and Instruction New#6_Attach 6A & 6D Screen and Guide
195663 #6, #7, and #8 Bundled Sub-studies for HINTS, MDC and NExT Form and Instruction New#7_Attach 7A 7C and 7E_MDC Cog Interview
195663 #6, #7, and #8 Bundled Sub-studies for HINTS, MDC and NExT Form and Instruction New#8_Attach 8A, 8E, 8F, & 8G_Email, Guide & Qx_NExT
193888 #3, #4, and #5 Bundled Sub-studies for Website Evaluations - Science of Team Science, SEER and Epi Genetics Research Programs Form and Instruction Unchanged#5 Attachments C2, C3, C4 & C5
193888 #3, #4, and #5 Bundled Sub-studies for Website Evaluations - Science of Team Science, SEER and Epi Genetics Research Programs Form and Instruction Unchanged#4 Attachments B2, B5, B6 & B7
193888 #3, #4, and #5 Bundled Sub-studies for Website Evaluations - Science of Team Science, SEER and Epi Genetics Research Programs Form and Instruction Unchanged#3 Attachments A1 and A4
188660 Pilot of a Survey Instrument Designed to Assess Users' Perceptions of Website Changes (Sub-Study #2) Form UnchangedSurvey to Evaluate Changes to Website Design
187577 Assessing Survivors' Cognitive, Affective and Information-Seeking Responses to Different Formats to Communicate Cancer Survival Statistics - Sub-Study #1 Form UnchangedScreener & Survey Sub-Study #1

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2011 05/31/2011 05/31/2011
1,200 0 600
1,200 0 600
0 0 0





Reginfo record details
6
table that charts list of burden
IC Title Form No. Form Name
#10 Sub-study "Health Information National Trends Survey 4 (HINTS 4) Pilot Test " 1
#3, #4, and #5 Bundled Sub-studies for Website Evaluations - Science of Team Science, SEER and Epi Genetics Research Programs 2, 1, 3 ,   ,  
#6, #7, and #8 Bundled Sub-studies for HINTS, MDC and NExT 2, 3, 1, 2, 1, 1 ,   ,   ,   ,   ,  
#9 Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of Cycle 1 Instrument 1
Assessing Survivors' Cognitive, Affective and Information-Seeking Responses to Different Formats to Communicate Cancer Survival Statistics - Sub-Study #1 1
Pilot of a Survey Instrument Designed to Assess Users' Perceptions of Website Changes (Sub-Study #2) 1

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 1,200 600 0 600 0 0
Annual Time Burden (Hours) 1,200 600 0 600 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No