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	Modified
OMB Supporting Statement B NINR_FSourceQx(rev 2-2012).doc Supporting Statement B	2012-02-07
Attachment 5- IRB Approval_NINR Funding Source Qx.pdf Supplementary Document	2012-02-07
Attachment 4-NIH Privacy officer memo.doc Supplementary Document	2012-02-07
Attachment 3-INFORMED CONSENT FUNDING SOURCE Q_v2(11-11-2011).doc Supplementary Document	2012-02-07
FundSourceQuestionnaire-ScreenShots rev 3.1.12.doc Supplementary Document	2012-03-06
OMB Supporting Statement_ A NINR_FSource Qx_6 (rev 2-2012).doc Supporting Statement A	2012-02-07

IC Document Collections

IC ID	Document Title	Status
199531	Researchers Form and Instruction	Modified

ICR Details

OMB Control No: 0925-0652	ICR Reference No: 201202-0925-002
Status: Historical Active	Previous ICR Reference No: 201109-0925-005
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: Approved without change	Conclusion Date: 03/08/2012
	Date Received in OIRA: 02/09/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	12 Months From Approved
Responses	1,840	0	0
Time Burden (Hours)	147	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Despite the multiple recommendations from the Institute of Medicine calling for investment in end-of-life and palliative care (EOL PC) research, there is a limited understanding of who the stakeholders in EOL PC science are, the funding trends for EOL PC science (now and in the future), and the impact of past, current, and future partnerships between government, philanthropic organizations, academic research institutes, and/or others in building this important field of science. While no data were available, findings from one review indicate that directed funding streams for EOL PC research by federal and major philanthropic sources are not fully addressing the breadth and depth of EOL PC scientific issues encompassing the field, and research funding may be shrinking. 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. As part of the EOL PC research needs assessment, the Funding Source Questionnaire will identify funding organizations of EOL PC research studies published from 1997 through 2010, when a funding source was not cited or the funding source information was unclear in the research publication. This information will be used in the analysis of the published EOL PC research literature to determine which, if any, agencies or organizations funded the published research. This information will aid in understanding EOL PC research funding trends so that future funding of EOL PC research grants can be better coordinated by NIH, other Federal agencies, and non-government organizations and philanthropic groups.

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Authorizing Statute(s): US Code: 42 USC 285q Name of Law: National Institute of Nursing Research
  

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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ICR Summary 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	1,840	0	0	1,840	0	0
Annual Time Burden (Hours)	147	0	0	147	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: This is a new data collection.

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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: 02/09/2012

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