Recruitment and Screening for the Insight into Determination of Exceptional Aging and Longevity (IDEAL) Study (NIA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Individuals	Form and Instruction	Modified	Available
Revised IDEAL Supporting Statement B_04_08_11.docx	Supporting Statement B	Uploaded 2011-04-08	Available
Attachment 7 IDEAL Instructions accompanying pre-visit mailing _1_20_11.doc	Supplementary Document	Uploaded 2011-01-27	Available
Attachment 6 IDEAL Home Pre-Visit Letter Version 1_20_11-1.doc	Supplementary Document	Uploaded 2011-01-27	Available
Attachment 4 IDEAL Brochure.pdf	Supplementary Document	Uploaded 2011-01-27	Available
Attachment 2 IDEAL Organizational Recruitment Letter_ 1_20_11.docx	Supplementary Document	Uploaded 2011-01-27	Available
Attachment 1 recruitment presentation.pdf	Supplementary Document	Uploaded 2011-01-27	Available
Attachment 3 IDEAL Recruitment Poster.pdf	Supplementary Document	Uploaded 2011-01-27	Available
Attachment 10 Written Informed Consent_IDEAL Home Screening_1-10-11.docx	Supplementary Document	Uploaded 2011-01-27	Available
Attachment 9 IDEAL_Script - PT Interview Consent.docx	Supplementary Document	Uploaded 2011-01-27	Available
Revised IDEAL Supporting Statement A_04_08_11.docx	Supporting Statement A	Uploaded 2011-04-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
195897	Individuals	Form and Instruction	Modified

ICR Details

OMB Control No: 0925-0631	ICR Reference No: 201102-0925-003
Status: Historical Active	Previous ICR Reference No: 201101-0925-002
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Recruitment and Screening for the Insight into Determination of Exceptional Aging and Longevity (IDEAL) Study (NIA)
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: 04/08/2011
	Date Received in OIRA: 02/04/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	36 Months From Approved
Responses	1,500	0	0
Time Burden (Hours)	701	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the project for which we are seeking OMB approval is to conduct recruitment and screening for the Insight into the Determination of Exceptional Aging and Longevity (IDEAL) Study. The IDEAL Study cohort will be compared to current Baltimore Longitudinal Study of Aging (BLSA) participants who were no longer healthy or fully functional when they reached the age of 80. A secondary objective of the IDEAL Study is to identify physiological, environmental and behavioral characteristics that are risk factors for loss of a person's healthy aging status over time.

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Authorizing Statute(s): PL: Pub.L. 93 - 296 88 Name of Law: Research on Aging 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:
	75 FR 57038	09/17/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 7781	12/14/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Individuals	1, 2, 3	Telephone Interview ,   Physical Exam ,   Phone Questionnaire

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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	1,500	0	0	1,500	0	0
Annual Time Burden (Hours)	701	0	0	701	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: $15,391

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 02/03/2011

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