National Survey of Organ Donation Attitudes and Practices

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 National Survey of Organ Donation Attitudes and Practices	Form and Instruction	Modified	Available
HRSA Organ Donor cognitive script q15e_02 07 2012.doc	Supplementary Document	Uploaded 2012-03-02	Available
OMB Supporting Statmt_B.doc	Supporting Statement B	Uploaded 2011-11-23	Available
OMB Supporting Statmt_A.doc	Supporting Statement A	Uploaded 2011-11-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6543	National Survey of Organ Donation Attitudes and Practices	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0290	ICR Reference No: 201112-0915-001
Status: Historical Active	Previous ICR Reference No: 200405-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: National Survey of Organ Donation Attitudes and Practices
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/23/2012
	Date Received in OIRA: 12/06/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved
Responses	3,250	0	0
Time Burden (Hours)	975	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Division of Transplantation (DoT), Healthcare Systems Bureau, Health Resources and Services Administration (HRSA) is planning to conduct a telephone survey of public knowledge, perceptions, opinion, and behaviors related to organ donation. The proposed study will identify current organ donation views and practices of the American public and various population subgroups using a survey instrument measuring issues such as public knowledge about and attitudes toward organ donation, public commitment to or willingness to donate, impediments to public willingness to donate, and attitudes toward living donation, donation practices, policy issues, allocation policy, presumed consent, and financial incentives for donation. Two national surveys using nearly identical survey instruments to identify public views and behaviors related to organ donation were conducted in 1993 and 2005, and results from this study will be utilized to track changes over time.

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Authorizing Statute(s): PL: Pub.L. 42 - 274 375 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:
	76 FR 1185	01/07/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 71578	11/18/2011
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
National Survey of Organ Donation Attitudes and Practices	1	Revised Survey

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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	3,250	0	0	3,250	0	0
Annual Time Burden (Hours)	975	0	0	975	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: The burden per respondent (.3 hours) will be the same as it was in the prior rounds (1993 and 2005) of this survey. However, there is an increase in the number of overall respondents selected for the current survey.

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Annual Cost to Federal Government: $0

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: 12/06/2011

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