California Health Interview Survey Cancer Control Module (CHIS-CCM) 2011 (NCI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2 Child Weight and Height Materials (CHIS-CCM 2009) (NCI)	Form and Instruction	Removed	Available
Form 1 CHIS Cancer Control Module 2011 for Adolescents (CHIS-CCM)	Form and Instruction	Modified	Available
Form 1 CHIS Cancer Control Module 2011 for Adults (CHIS-CCM)	Form and Instruction	Modified	Available
B 2 2 OMB - CHIS 2011 Response_4-8-2011.docx	Supplementary Document	Uploaded 2011-04-08	Available
SSB_12-17-2010_CHIS-CCM.doc	Supporting Statement B	Uploaded 2011-01-14	Available
Attach 11 CHIS Geographic Strata and Selection Probabilities 31AUG2010.docx	Supplementary Document	Uploaded 2011-01-14	Available
Attach 10 CHIS Data Security Policies.pdf	Supplementary Document	Uploaded 2011-01-14	Available
Attach 9 Certificate of Confidentiality.pdf	Supplementary Document	Uploaded 2011-01-14	Available
Attach 8 IRB and OHSR Approvals_1-10-2011.pdf	Supplementary Document	Uploaded 2011-01-14	Available
Attach 7 Memo from NIH Privacy Officer.pdf	Supplementary Document	Uploaded 2011-01-14	Available
Attach 6 Subject Contact Materials.pdf	Supplementary Document	Uploaded 2011-01-14	Available
Attach 5A-F Board and Committee Memberships.pdf	Supplementary Document	Uploaded 2011-01-14	Available
Attach 4 PIAs.pdf	Supplementary Document	Uploaded 2011-01-14	Available
Attach 3 CHIS Making An Impact.pdf	Supplementary Document	Uploaded 2011-01-14	Available
Attach 2 Organizations and Publications Using CHIS.pdf	Supplementary Document	Uploaded 2011-01-14	Available
Cover Memo_CHIS 2011.doc	Supplementary Document	Uploaded 2011-01-14	Available
SSA_1-9-2010_CHIS-CCM.doc	Supporting Statement A	Uploaded 2011-01-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
187240	Child Weight and Height Materials (CHIS-CCM 2009) (NCI)	Form and Instruction	Removed
187239	CHIS Cancer Control Module 2011 for Adolescents (CHIS-CCM)	Form and Instruction	Modified
187238	CHIS Cancer Control Module 2011 for Adults (CHIS-CCM)	Form and Instruction	Modified

ICR Details

OMB Control No: 0925-0598	ICR Reference No: 201102-0925-006
Status: Historical Active	Previous ICR Reference No: 200811-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: California Health Interview Survey Cancer Control Module (CHIS-CCM) 2011 (NCI)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/08/2011
	Date Received in OIRA: 02/15/2011
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	04/30/2011
Responses	18,058	0	26,723
Time Burden (Hours)	2,207	0	3,437
Cost Burden (Dollars)	0	0	0

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Abstract: The NCI has sponsored five Cancer Control Modules in the California Health Interview Survey (CHIS), and will be sponsoring a sixth to be administered in 2011. CHIS is a telephone survey that collects population-based, standardized health-related data to assess California's progress in meeting Healthy People 2010 objectives for the nation and the state. The purpose of CHIS-CCM is to collect data to allow NCI to examine patterns and trends in cancer screening and follow-up, as well as to study other cancer-related topics such as diet and physical activity, by collecting data on health- and disease-related topics such as patterns and trends in cancer screening, disease risk factors, disease outcomes, and family history of disease. Additionally, CHIS is designed to be comparable to the National Health Interview Survey (NHIS) data in order to conduct comparative analyses. CHIS provides enhanced estimates for cancer risk factors and screening among racial/ethnic minority populations.

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Authorizing Statute(s): US Code: 42 USC 285a Name of Law: Public Health Service Act
   US Code: 42 USC 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:
	75 FR 69681	11/15/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 2398	01/13/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
CHIS Cancer Control Module 2011 for Adults (CHIS-CCM)	1	CHIS-CCM 2011
CHIS Cancer Control Module 2011 for Adolescents (CHIS-CCM)	1	CHIS-CCM 2011
Child Weight and Height Materials (CHIS-CCM 2009) (NCI)	2	Child Weight and Height Materials

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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	18,058	26,723	0	-8,665	0	0
Annual Time Burden (Hours)	2,207	3,437	0	-1,230	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The CHIS-CCM 2011 is being submitted to OMB as a revised collection of information, also known as a program change due to agency discretion. This program change involves both design change and content change in the questionnaire. CHIS will shift from a biennial to a continuous survey design in 2011, with data collected continuously throughout the year. Health-related modules of interest that have been added to this survey include questions relating to human papillomavirus (HPV), epilepsy, medical homes, and health-related quality of life (HRQOL) scale (see Section A.1 for more details about inclusion of these modules). Additionally, questions were added to the cancer screening module related to Computerized Axial Tomography (CAT) or Computed Tomography (CT) scans. Deleted modules from the 2008 CHIS were related to cancer prevention health behaviors, VA topics, and discrimination. There is a slight decrease in burden from the 2009 OMB approved submission due to a reduction in the estimated number of adolescents who will complete the survey, and removal of the proposed child weight-height pilot study. The estimated number of adolescents who will complete the survey is smaller due to the proposed program change. During previous biennial sampling cycles, CHIS fielding periods overlapped with summer months. With the continuous survey, surveys will be conducted throughout the year resulting in a more consistent sampling throughout the school year and summer. Fewer adolescents will be available in sampled households during the school year, relative to during the summer months, due to school and extracurricular activities.

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Annual Cost to Federal Government: $1,397,011

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: 02/04/2011

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