End-of-Life and Palliative Care Science Needs Assessment: Funding Source Questionnaire (NINR)

Forms and Documents

Document Name	Status
Form 1 Researchers Form and Instruction	New
OMB Supporting Statement B NINR_FSourceQxv2.docx Supporting Statement B	2011-09-14
Attachment 5- IRB Approval_NINR Funding Source Qx.pdf Supplementary Document	2011-09-14
Attachment 4-NIH Privacy officer memo.docx Supplementary Document	2011-09-14
Attachment 2- EMAIL INVITATION LETTER.doc Supplementary Document	2011-09-14
Attachment 3-INFORMED CONSENT FUNDING SOURCE Q_v2.docx Supplementary Document	2011-09-14
OMB Supporting Statement_ A NINR_FSource Qx_6.doc Supporting Statement A	2011-09-14

IC Document Collections

IC ID	Document Title	Status
199531	Researchers Form and Instruction	New

ICR Details

OMB Control No: 0925-0652	ICR Reference No: 201109-0925-005
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: End-of-Life and Palliative Care Science Needs Assessment: Funding Source Questionnaire (NINR)
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 12/06/2011
	Date Received in OIRA: 09/28/2011
Terms of Clearance: Withdrawn at the request of NIH. When resubmitting, NIH will provide revised documents and screen shots.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		04/30/2012
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Institute for Nursing Research (NINR) seeks to implement a needs assessment of EOL PC science funding trends and topics. This formative data will inform NINR, NIH Institutes and Centers, and other Federal and non-Federal Agencies about current EOL PC funding trends and priorities and create synergies for federal, private, and academic research networks to stimulate research capacity in this field.

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Authorizing Statute(s): US Code: 42 USC 285q Name of Law: NINR's Activities
  

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:
	76 FR 35221	06/16/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 59145	09/23/2011
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Researchers	1	Funding Source Questionnaire

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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: $30,736

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: 09/28/2011

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