Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Screenshots of CGH Kenya Survey	Form	New	Available
Form 1 Cancer Control Leadership Forum Survey	Form	New	Available
Form 1 CGH Meeting Survey	Form and Instruction	New	Available
Form 2B CPTAC Survey screenshots	Form and Instruction	New	Available
Form 1B TCGA Survey Screenshots	Form and Instruction	New	Available
Form 1 Moderator's Guide	Form and Instruction	New	Available
Form 2 Consent Form	Form and Instruction	New	Available
Form 1 Survey	Form and Instruction	New	Available
Form 4 Debriefing Interview for Feds	Form and Instruction	New	Available
Form 3 Initial Screenshot of CAT	Form and Instruction	New	Available
Form 2 Item Bank Physical Function Questions	Form and Instruction	New	Available
Form 1 Item Bank Behavioral Health Questions	Form and Instruction	New	Available
Form 1 PIO Survey	Form and Instruction	New	Available
Form 1 CGH Global Meeting Survey	Form and Instruction	New	Available
Form 1 BBRB Standards Survey	Form and Instruction	New	Available
Form 1 Facilitator Conducted Survey	Form and Instruction	New	Available
Form 2 CCT Usability Script	Form and Instruction	New	Available
Form 1 CCT Screener	Form and Instruction	New	Available
Form 3 Facilitator's Guides for All Groups	Form and Instruction	New	Available
Form 2 OCS Screener for Professionals	Form and Instruction	New	Available
Form 1 OCS Screener for Public	Form and Instruction	New	Available
Form 3 Day 3 Script	Form and Instruction	New	Available
Form 2 Day 1 Script	Form and Instruction	New	Available
Form 1 Screener_Life	Form and Instruction	New	Available
Form 3 Recruit Phone Call	Form and Instruction	New	Available
Form 2 Facilitator's Guide - Measures	Form and Instruction	New	Available
Form 1 Facilitator's Guide - Catalogue	Form and Instruction	New	Available
Form 6 DCP NSRG Facilitator's Guide	Form and Instruction	New	Available
Form 5 DCP NSRG Screener	Form and Instruction	New	Available
Form 4 DCPDIV #21 Facilitator's Guide	Form and Instruction	New	Available
Form 3 DCPDIV #21 Screener	Form and Instruction	New	Available
Form 2 CPCC #20 Facilitator's Guide	Form and Instruction	New	Available
Form 1 CPCC #20 Screener	Form and Instruction	New	Available
Form 1 EGRP Listserv Survey	Form and Instruction	New	Available
Form 2 Usability Test	Form and Instruction	New	Available
Form 1 Screener	Form and Instruction	New	Available
Form 1 Moderator's Guide	Form and Instruction	New	Available
Form 1 RTR Survey	Form and Instruction	New	Available
Form 2 Update CCR Mailing List	Form and Instruction	New	Available
Form 1 Join CCR Mailing List	Form and Instruction	New	Available
Form 1 Moderator's Guide	Form and Instruction	New	Available
Form 5 #12 Smokefree.gov Screenshots Part 2	Form and Instruction	New	Available
Form 4 #12 Smokefree.gov Screenshots Part 1	Form and Instruction	New	Available
Form 3 Follow-Up Survey_Spanish	Form and Instruction	New	Available
Form 2 Follow-Up Survey_Portuguese	Form and Instruction	New	Available
Form 1 Follow-Up Survey_English	Form and Instruction	New	Available
Form 1 HD Calc Survey	Form and Instruction	New	Available
Form 1 Full Survey with Skips	Form and Instruction	New	Available
Form 3G #7_Attach2G_Advisors	Form and Instruction	New	Available
Form 3H #7_Attach2H_Trainees	Form and Instruction	New	Available
Form 3F #7_Attach2F_Advocates	Form and Instruction	New	Available
Form 3E #7_Attach2E_Outreach	Form and Instruction	New	Available
Form 3D #7_Attach2D_Project Investigators	Form and Instruction	New	Available
Form 3C #7_Attach2C_Principal	Form and Instruction	New	Available
Form 3B #7_Attach2B_Education	Form and Instruction	New	Available
Form 3A #7_Attach 2A_Administrators	Form and Instruction	New	Available
Form 2 R2R Survey	Form and Instruction	New	Available
Form 1 DCP Survey Screenshots	Form and Instruction	New	Available
Form 2 Attach 4 CogInterview Screen & Pre-and Post-tests	Form and Instruction	New	Available
Form 5 Attach 10 Use Test Interview Guide & Questions	Form and Instruction	New	Available
Form 4 Attach 8 MP Interviews Guide & Questions	Form and Instruction	New	Available
Form 3 Attach 6 Focus Group Screen & Questions	Form and Instruction	New	Available
Form 1 Attach 2 Beta Test Screen & Survey	Form and Instruction	New	Available
Form 3F SEER Moderator Guide for Media	Form and Instruction	New	Available
Form 3D SEER Moderator Guide for HC Professionals	Form and Instruction	New	Available
Form 3E SEER Moderator Guide for Researcher	Form and Instruction	New	Available
Form 3C SEER Moderator Guide for Public	Form and Instruction	New	Available
Form 3A and 3B SEER Screener for HC Prof and Public	Form and Instruction	New	Available
Form 2.1 and 2.5 DCEG Facilitator's Guide and System Usability Scale	Form and Instruction	New	Available
Form 1A TCGA Email and Survey	Form and Instruction	New	Available
Draft Generic Clearance Submission Template[1].docx	Supplementary Document	Uploaded 2011-09-15	Available
SSB Generic NCI Fast Track.docx	Supporting Statement B	Uploaded 2011-08-10	Available
SSA Generic NCI Fast Track.docx	Supporting Statement A	Uploaded 2011-08-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
211385	Satisfaction with Kenya Cancer Control and Cancer Research Stakeholder Meeting	Form	New	Screenshots of CGH Kenya Survey
210968	Sub-study #38_Cancer Control Leadership Forum CCLF	Form	New	Cancer Control Leadership Forum Survey
210407	Sub-study #37_Revised Satisfaction Survey for the Symposium on Global Cancer Research 2014	Form and Instruction	New	CGH Meeting Survey
210298	#36 Clinical Proteomic Tumor Analysis Consortium (CPTAC) Surveys	Form and Instruction	New	CPTAC Survey screenshots
210298	#36 Clinical Proteomic Tumor Analysis Consortium (CPTAC) Surveys	Form and Instruction	New	TCGA Survey Screenshots
209773	Sub-study #35_Cognitive Interviewing for Item Bank in Computer Adaptive Testing Instrument	Form and Instruction	New	Moderator's Guide
209773	Sub-study #35_Cognitive Interviewing for Item Bank in Computer Adaptive Testing Instrument	Form and Instruction	New	Consent Form
209600	Sub-study #34_NCI Office of Cancer Nanotechnology Laboratory (caNanoLab) Survey	Form and Instruction	New	Survey
209220	Sub-study #33_User Simulation Study for NIH-SSA Collaboration to Improve Disability Determination (Revised)	Form and Instruction	New	Debriefing Interview for Feds
209220	Sub-study #33_User Simulation Study for NIH-SSA Collaboration to Improve Disability Determination (Revised)	Form and Instruction	New	Initial Screenshot of CAT
209220	Sub-study #33_User Simulation Study for NIH-SSA Collaboration to Improve Disability Determination (Revised)	Form and Instruction	New	Item Bank Physical Function Questions
209220	Sub-study #33_User Simulation Study for NIH-SSA Collaboration to Improve Disability Determination (Revised)	Form and Instruction	New	Item Bank Behavioral Health Questions
208300	Sub-study #32_Protocol and Information Office (PIO) External Customer Satisfaction Survey	Form and Instruction	New	PIO Survey
207182	Sub-study #29_Satisfaction with Global Cancer Research Day 2013	Form and Instruction	New	CGH Global Meeting Survey
206942	Sub-study #28_Customer Satisfaction and Feedback about the NCI Best Practices for Biospecimen Resources	Form and Instruction	New	BBRB Standards Survey
206877	Sub-study #27_Satisfaction with Cancer Research Programs in Underserved Communities (CGH)	Form and Instruction	New	Facilitator Conducted Survey
206754	REVISED Sub-study #25_ Center for Cancer Training (CCT) Web Site Usability Testing	Form and Instruction	New	CCT Usability Script
206754	REVISED Sub-study #25_ Center for Cancer Training (CCT) Web Site Usability Testing	Form and Instruction	New	CCT Screener
206546	Sub-study #24 - Needs Assessment for the NCI Office of Cancer Survivorship's Web site (OCS)	Form and Instruction	New	Facilitator's Guides for All Groups
206546	Sub-study #24 - Needs Assessment for the NCI Office of Cancer Survivorship's Web site (OCS)	Form and Instruction	New	OCS Screener for Professionals
206546	Sub-study #24 - Needs Assessment for the NCI Office of Cancer Survivorship's Web site (OCS)	Form and Instruction	New	OCS Screener for Public
206211	Sub-study #26_Life in A Day Phone Application Study (Usability Study)	Form and Instruction	New	Day 3 Script
206211	Sub-study #26_Life in A Day Phone Application Study (Usability Study)	Form and Instruction	New	Day 1 Script
206211	Sub-study #26_Life in A Day Phone Application Study (Usability Study)	Form and Instruction	New	Screener_Life
205913	Sub-study #23 NCCOR Website Usability Testing	Form and Instruction	New	Recruit Phone Call
205913	Sub-study #23 NCCOR Website Usability Testing	Form and Instruction	New	Facilitator's Guide - Measures
205913	Sub-study #23 NCCOR Website Usability Testing	Form and Instruction	New	Facilitator's Guide - Catalogue
205388	Bundled Sub-studies #20, #21 and #22 Website Usability Testing	Form and Instruction	New	DCP NSRG Facilitator's Guide
205388	Bundled Sub-studies #20, #21 and #22 Website Usability Testing	Form and Instruction	New	DCP NSRG Screener
205388	Bundled Sub-studies #20, #21 and #22 Website Usability Testing	Form and Instruction	New	DCPDIV #21 Facilitator's Guide
205388	Bundled Sub-studies #20, #21 and #22 Website Usability Testing	Form and Instruction	New	DCPDIV #21 Screener
205388	Bundled Sub-studies #20, #21 and #22 Website Usability Testing	Form and Instruction	New	CPCC #20 Facilitator's Guide
205388	Bundled Sub-studies #20, #21 and #22 Website Usability Testing	Form and Instruction	New	CPCC #20 Screener
205174	Sub-study #19_Epidemiology and Genomics Research Program (EGRP) Communications Survey	Form and Instruction	New	EGRP Listserv Survey
205054	Sub-study #18_Cancer Imaging Program (CIP) Web Site Usability Testing	Form and Instruction	New	Usability Test
205054	Sub-study #18_Cancer Imaging Program (CIP) Web Site Usability Testing	Form and Instruction	New	Screener
204499	Sub-Study #16 - International Focus Group to Inform Economic Barriers and Challenges to Biobankers	Form and Instruction	New	Moderator's Guide
203874	Sub-Study #15: The Surveillance, Epidemiology, and End Results (SEER) Residual Tissue Repository Program: Survey to Assess Service Delivery and Product Quality	Form and Instruction	New	RTR Survey
203094	Sub-study #14 - CCR Clinical Trials at NIH - Join Our Mailing List/Update Your Profile Business Contact Information	Form and Instruction	New	Update CCR Mailing List
203094	Sub-study #14 - CCR Clinical Trials at NIH - Join Our Mailing List/Update Your Profile Business Contact Information	Form and Instruction	New	Join CCR Mailing List
202647	Sub-study #13 - Focus Groups to Assess Implementation of the NCCCP-developed Template for Community Outreach (TCO)	Form and Instruction	New	Moderator's Guide
202292	Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)	Form and Instruction	New	#12 Smokefree.gov Screenshots Part 2
202292	Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)	Form and Instruction	New	#12 Smokefree.gov Screenshots Part 1
202292	Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)	Form and Instruction	New	Follow-Up Survey_Spanish
202292	Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)	Form and Instruction	New	Follow-Up Survey_Portuguese
202292	Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)	Form and Instruction	New	Follow-Up Survey_English
202114	Sub-Study #9 & #10 - HD*Calc Customer Satisfaction Survey for Different Category of Respondents: State (#9) and Federal Respondents (#10)	Form and Instruction	New	HD Calc Survey
201596	Sub-study #8_HD*Calc Customer Satisfaction Survey for Private Sector Respondents	Form and Instruction	New	Full Survey with Skips
201419	Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey	Form and Instruction	New	#7_Attach2G_Advisors
201419	Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey	Form and Instruction	New	#7_Attach2H_Trainees
201419	Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey	Form and Instruction	New	#7_Attach2F_Advocates
201419	Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey	Form and Instruction	New	#7_Attach2E_Outreach
201419	Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey	Form and Instruction	New	#7_Attach2D_Project Investigators
201419	Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey	Form and Instruction	New	#7_Attach2C_Principal
201419	Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey	Form and Instruction	New	#7_Attach2B_Education
201419	Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey	Form and Instruction	New	#7_Attach 2A_Administrators
201419	Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey	Form and Instruction	New	R2R Survey
201419	Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey	Form and Instruction	New	DCP Survey Screenshots
200992	Sub-study #4_Multi-Part Plan for Research and Development of the Solar Cell Mobile Application	Form and Instruction	New	Attach 4 CogInterview Screen & Pre-and Post-tests
200992	Sub-study #4_Multi-Part Plan for Research and Development of the Solar Cell Mobile Application	Form and Instruction	New	Attach 10 Use Test Interview Guide & Questions
200992	Sub-study #4_Multi-Part Plan for Research and Development of the Solar Cell Mobile Application	Form and Instruction	New	Attach 8 MP Interviews Guide & Questions
200992	Sub-study #4_Multi-Part Plan for Research and Development of the Solar Cell Mobile Application	Form and Instruction	New	Attach 6 Focus Group Screen & Questions
200992	Sub-study #4_Multi-Part Plan for Research and Development of the Solar Cell Mobile Application	Form and Instruction	New	Attach 2 Beta Test Screen & Survey
200808	Revised Bundled Sub-study #2 and #3_Usability Testing for DCEG Newsletter Linkage and SEER Consolidated Cancer Statistics Tool	Form and Instruction	New	SEER Moderator Guide for Media
200808	Revised Bundled Sub-study #2 and #3_Usability Testing for DCEG Newsletter Linkage and SEER Consolidated Cancer Statistics Tool	Form and Instruction	New	SEER Moderator Guide for HC Professionals
200808	Revised Bundled Sub-study #2 and #3_Usability Testing for DCEG Newsletter Linkage and SEER Consolidated Cancer Statistics Tool	Form and Instruction	New	SEER Moderator Guide for Researcher
200808	Revised Bundled Sub-study #2 and #3_Usability Testing for DCEG Newsletter Linkage and SEER Consolidated Cancer Statistics Tool	Form and Instruction	New	SEER Moderator Guide for Public
200808	Revised Bundled Sub-study #2 and #3_Usability Testing for DCEG Newsletter Linkage and SEER Consolidated Cancer Statistics Tool	Form and Instruction	New	SEER Screener for HC Prof and Public
200808	Revised Bundled Sub-study #2 and #3_Usability Testing for DCEG Newsletter Linkage and SEER Consolidated Cancer Statistics Tool	Form and Instruction	New	DCEG Facilitator's Guide and System Usability Scale
199727	Sub-study #1_The Cancer Genome Atlas (TCGA) Data User Platform Survey	Form and Instruction	New	TCGA Email and Survey

ICR Details

OMB Control No: 0925-0642	ICR Reference No: 201108-0925-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
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 without change	Conclusion Date: 09/20/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/16/2011
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2014	36 Months From Approved
Responses	6,500	0	0
Time Burden (Hours)	8,750	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable NIH to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with NIH's programs.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: SETTING CUSTOMER SERVICE STANDARDS
  

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 80542	12/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 44938	07/27/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 29

table that charts list of burden

IC Title	Form No.	Form Name
#36 Clinical Proteomic Tumor Analysis Consortium (CPTAC) Surveys	1B, 2B	TCGA Survey Screenshots ,   CPTAC Survey screenshots
Bundled Sub-studies #20, #21 and #22 Website Usability Testing	1, 2, 3, 4, 5, 6	CPCC #20 Screener ,   CPCC #20 Facilitator's Guide ,   DCPDIV #21 Screener ,   DCPDIV #21 Facilitator's Guide ,   DCP NSRG Screener ,   DCP NSRG Facilitator's Guide
Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey	1, 2, 3A, 3B, 3C, 3D, 3E, 3F, 3H, 3G	DCP Survey Screenshots ,   R2R Survey ,   #7_Attach 2A_Administrators ,   #7_Attach2B_Education ,   #7_Attach2C_Principal ,   #7_Attach2D_Project Investigators ,   #7_Attach2E_Outreach ,   #7_Attach2F_Advocates ,   #7_Attach2H_Trainees ,   #7_Attach2G_Advisors
REVISED Sub-study #25_ Center for Cancer Training (CCT) Web Site Usability Testing	1, 2	CCT Screener ,   CCT Usability Script
Revised Bundled Sub-study #2 and #3_Usability Testing for DCEG Newsletter Linkage and SEER Consolidated Cancer Statistics Tool	2.1 and 2.5, 3A and 3B, 3C, 3E, 3D, 3F	DCEG Facilitator's Guide and System Usability Scale ,   SEER Screener for HC Prof and Public ,   SEER Moderator Guide for Public ,   SEER Moderator Guide for Researcher ,   SEER Moderator Guide for HC Professionals ,   SEER Moderator Guide for Media
Satisfaction with Kenya Cancer Control and Cancer Research Stakeholder Meeting	1	Screenshots of CGH Kenya Survey
Sub-Study #15: The Surveillance, Epidemiology, and End Results (SEER) Residual Tissue Repository Program: Survey to Assess Service Delivery and Product Quality	1	RTR Survey
Sub-Study #16 - International Focus Group to Inform Economic Barriers and Challenges to Biobankers	1	Moderator's Guide
Sub-Study #9 & #10 - HD*Calc Customer Satisfaction Survey for Different Category of Respondents: State (#9) and Federal Respondents (#10)	1	HD Calc Survey
Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)	1, 2, 3, 4, 5	Follow-Up Survey_English ,   Follow-Up Survey_Portuguese ,   Follow-Up Survey_Spanish ,   #12 Smokefree.gov Screenshots Part 1 ,   #12 Smokefree.gov Screenshots Part 2
Sub-study #13 - Focus Groups to Assess Implementation of the NCCCP-developed Template for Community Outreach (TCO)	1	Moderator's Guide
Sub-study #14 - CCR Clinical Trials at NIH - Join Our Mailing List/Update Your Profile Business Contact Information	1, 2	Join CCR Mailing List ,   Update CCR Mailing List
Sub-study #18_Cancer Imaging Program (CIP) Web Site Usability Testing	1, 2	Screener ,   Usability Test
Sub-study #19_Epidemiology and Genomics Research Program (EGRP) Communications Survey	1	EGRP Listserv Survey
Sub-study #1_The Cancer Genome Atlas (TCGA) Data User Platform Survey	1A	TCGA Email and Survey
Sub-study #23 NCCOR Website Usability Testing	1, 2, 3	Facilitator's Guide - Catalogue ,   Facilitator's Guide - Measures ,   Recruit Phone Call
Sub-study #24 - Needs Assessment for the NCI Office of Cancer Survivorship's Web site (OCS)	1, 2, 3	OCS Screener for Public ,   OCS Screener for Professionals ,   Facilitator's Guides for All Groups
Sub-study #26_Life in A Day Phone Application Study (Usability Study)	1, 2, 3	Screener_Life ,   Day 1 Script ,   Day 3 Script
Sub-study #27_Satisfaction with Cancer Research Programs in Underserved Communities (CGH)	1	Facilitator Conducted Survey
Sub-study #28_Customer Satisfaction and Feedback about the NCI Best Practices for Biospecimen Resources	1	BBRB Standards Survey
Sub-study #29_Satisfaction with Global Cancer Research Day 2013	1	CGH Global Meeting Survey
Sub-study #32_Protocol and Information Office (PIO) External Customer Satisfaction Survey	1	PIO Survey
Sub-study #33_User Simulation Study for NIH-SSA Collaboration to Improve Disability Determination (Revised)	1, 2, 3, 4	Item Bank Behavioral Health Questions ,   Item Bank Physical Function Questions ,   Initial Screenshot of CAT ,   Debriefing Interview for Feds
Sub-study #34_NCI Office of Cancer Nanotechnology Laboratory (caNanoLab) Survey	1	Survey
Sub-study #35_Cognitive Interviewing for Item Bank in Computer Adaptive Testing Instrument	2, 1	Consent Form ,   Moderator's Guide
Sub-study #37_Revised Satisfaction Survey for the Symposium on Global Cancer Research 2014	1	CGH Meeting Survey
Sub-study #38_Cancer Control Leadership Forum CCLF	1	Cancer Control Leadership Forum Survey
Sub-study #4_Multi-Part Plan for Research and Development of the Solar Cell Mobile Application	3, 1, 4, 5, 2	Attach 2 Beta Test Screen & Survey ,   Attach 6 Focus Group Screen & Questions ,   Attach 8 MP Interviews Guide & Questions ,   Attach 10 Use Test Interview Guide & Questions ,   Attach 4 CogInterview Screen & Pre-and Post-tests
Sub-study #8_HD*Calc Customer Satisfaction Survey for Private Sector Respondents	1	Full Survey with Skips

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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	6,500	0	0	6,500	0	0
Annual Time Burden (Hours)	8,750	0	0	8,750	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: Not applicable. This is a new request for a generic ICR.

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Annual Cost to Federal Government: $300,000

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: 08/16/2011

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