Information Collection Request

Questionnaire Cognitive Interviewing and Pretesting (NCI)

ICR 201302-0925-007 · OMB 0925-0589 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 1 Sub-study #10_Requirement Gathering for a Biobank Economic Modeling Tool (BEMT) Form and Instruction New Repair queued
Form 1 Sub-study #9_Health Information National Trends Survey 4 (HINTS 4) Cog Test of Cycle 4 (Revised) Form and Instruction New Repair queued
Form 1 Sub-study #7_Development of Consensus Measures of Distress for the Grid Enabled Measures-Distress Measurement (GEM-DM) Workspace Form and Instruction New Repair queued
Form 1 Sub-study #6_Resubmission of Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of HINTS-FDA Instrument Form and Instruction New Available
Form 1 Sub-study #7_Survey Instrument Designed to Assess Users' Perceptions of Website Changes Form and Instruction New Repair queued
Form 3 Sub-study #5: Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of Cycle 3 Instrument Form and Instruction Modified Available
Form 2 Sub-study #4: Cognitive Testing of the Family Life, Activity, Sun, Health, and Eating (FLASHE) Survey Form and Instruction Modified Repair queued
Form 2 Sub-study #3_Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of Cycle 2 Instrument Form and Instruction Modified Available
Form 1 Bundled Website Usability Testings #1 (ASA24) and #2 (GEM) Form and Instruction Modified Repair queued
Change Request memo_0925-0589 GW.doc Justification for No Material/Nonsubstantive Change Uploaded 2013-02-22 Available
Attach G_IRB Approval.pdf Supplementary Document Uploaded 2013-02-27 Available
Attach F_Reminder Letter.docx Supplementary Document Uploaded 2013-02-27 Repair queued
Attach D_Advertisements.docx Supplementary Document Uploaded 2013-02-27 Repair queued
Attach C-2_Consent Form Spanish.docx Supplementary Document Uploaded 2013-02-27 Available
Attach A-2_Questionnaire to Test_Spanish.docx Supplementary Document Uploaded 2013-02-27 Repair queued
Attach A-1_Questionnaire to Test_English.docx Supplementary Document Uploaded 2013-02-27 Available
Justif Memo 12-5-12.doc Supplementary Document Uploaded 2013-02-27 Repair queued
Attach C-1_Consent Form English.docx Supplementary Document Uploaded 2013-02-27 Repair queued
Attach 4E FLASHE Cognitive Testing Plan.docx Supplementary Document Uploaded 2013-02-27 Repair queued
Attach 4D Reminder Letter-Email.docx Supplementary Document Uploaded 2013-02-27 Repair queued
Justification Memo.doc Supplementary Document Uploaded 2013-02-27 Available
Generic Sub-Study Form.doc Supplementary Document Uploaded 2013-02-27 Repair queued
Attach 4C Informed Consent Forms - Parent and Teen.docx Supplementary Document Uploaded 2013-02-27 Repair queued
#3_Justif_MemoAttachments_C_D_F_G_HINTS_Cycle2_01-12-12.DOC Supplementary Document Uploaded 2013-02-27 Available
#2_Justifi Memo Attach 2A 2B_GEM_FINAL.docx Supplementary Document Uploaded 2013-02-27 Available
Gen IC Forms #1 and #2_ASA-24 & GEM Usability Testing.doc Supplementary Document Uploaded 2013-02-27 Repair queued
Memo to OMB_Key To Bundled #1 and #2.doc Supplementary Document Uploaded 2013-02-27 Repair queued
#1 Justif Memo Attach 1B 1D_5-18-2011.doc Supplementary Document Uploaded 2013-02-27 Repair queued
ICR Details
0925-0589 201302-0925-007
Historical Active 201103-0925-004
HHS/NIH 18889
Questionnaire Cognitive Interviewing and Pretesting (NCI)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 03/04/2013
Retrieve Notice of Action (NOA) 02/28/2013
  Inventory as of this Action Requested Previously Approved
04/30/2014 04/30/2014 04/30/2014
4,800 0 3,600
6,000 0 3,600
0 0 0

A generic clearance is requested from OMB for general questionnaire development and pretesting activities to be carried out in 2011-2014 by the staff of the Applied Research Program, in the Division of Cancer Control and Population Sciences. Four types of activities will be carried out: survey questionnaire development and pretesting based on cognitive interviewing methodology, research on the cognitive aspects of survey methodology, research on computer-user interface design for computer-assisted instruments (including Web-based surveys), also known as Usability Testing, and Pilot Household interviews.

US Code: 42 USC 410 Name of Law: Public Health Service Act
   US Code: 42 USC 412 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  75 FR 79009 12/17/2010
76 FR 12979 03/09/2011
No

9
IC Title Form No. Form Name
Sub-study #9_Health Information National Trends Survey 4 (HINTS 4) Cog Test of Cycle 4 (Revised) 2, 1, 3, 4, 5, 6 Screener - Revised - English ,   Screener - Revised - Spanish ,   Consent Form - English ,   Consent Form - Spanish ,   Interview Protocol - English ,   Interview Protocol - Spanish
Sub-study #4: Cognitive Testing of the Family Life, Activity, Sun, Health, and Eating (FLASHE) Survey 2, 3, 4, 1, 5, 6, 7 Parent Diet and Demographic Survey ,   Parent Physical Activity Survey and Checklist ,   Teen Diet and Demographic Survey ,   FLASHE Screener ,   Teen Physical Activity Survey and Recall ,   Parent Cognitive Interview Guide ,   Teen Cognitive Interview Guide
Sub-study #5: Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of Cycle 3 Instrument 3, 2, 4, 1 Interview Protocol (English) ,   Screener (Spanish) ,   Interview Protocol (Spanish) ,   Screener (English)
Sub-study #7_Survey Instrument Designed to Assess Users' Perceptions of Website Changes 1 ARP Website Survey
Sub-study #10_Requirement Gathering for a Biobank Economic Modeling Tool (BEMT) 1, 2 Survey Screenshots ,   Follow-Up-Debriefing
Bundled Website Usability Testings #1 (ASA24) and #2 (GEM) 1, 2 #1_ASA 24 Screener and Guide ,   #2_GEM Attach 2C 2D Survey and Guide
Sub-study #3_Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of Cycle 2 Instrument 2, 1, 3 HINTS Cycle 2 Cognitive Interview Protocol ,   HINTS Cycle 2 Questionnaire ,   HINTS Cycle 2 Screener
Sub-study #6_Resubmission of Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of HINTS-FDA Instrument 4, 3, 1, 2 English Screener ,   Spanish Screener ,   Spanish Cognitive Interview Script ,   English Cognitive Interview Script
Sub-study #7_Development of Consensus Measures of Distress for the Grid Enabled Measures-Distress Measurement (GEM-DM) Workspace 1 GEM-DM Survey

  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 4,800 3,600 0 1,200 0 0
Annual Time Burden (Hours) 6,000 3,600 0 2,400 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
It is anticipated that a generic sub-study will be submitted shortly to request approval to perform formative research necessary to calibrate a self-report instrument to collect information relevant to Social Security Disability Insurance, from the NIH Clinical Center, and that testing is anticipated to require the use of approximately 2,200 hours. As a result, the program staff is asking for an increase in burden hours from 3,600 hours to 6,000 hours to accommodate this interest.

$244,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Mikia Currie 3014350941

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
02/28/2013