Change Request for 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 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
CHIS Change Request_6-14-11.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2011-06-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
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: 201106-0925-005
Status: Historical Active	Previous ICR Reference No: 201102-0925-006
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Change Request for California Health Interview Survey Cancer Control Module (CHIS-CCM) 2011 (NCI)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/20/2011
	Date Received in OIRA: 06/30/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	04/30/2014	04/30/2014
Responses	18,058	0	18,058
Time Burden (Hours)	2,207	0	2,207
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-1 Name of Law: Public Health Service Act
   US Code: 42 USC 285a 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

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 Modified Change
CHIS Cancer Control Module 2011 for Adolescents (CHIS-CCM)	1	CHIS-CCM 2011

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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	18,058	0	0	0	0
Annual Time Burden (Hours)	2,207	2,207	0	0	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: No

Burden Reduction Due to:

Short Statement:

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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: 06/30/2011

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