Sub-study #10_Requirement Gathering for a Biobank Economic Modeling Tool (BEMT)

Questionnaire Cognitive Interviewing and Pretesting (NCI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0589 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Sub-study #10_Requirement Gathering for a Biobank Economic Modeling Tool (BEMT) Form and Instruction
1 Survey Screenshots Attach2_BEMT Survey Screenshots_10FEB2014.pdf Form and Instruction
2 Follow-Up-Debriefing Attach4-BEMT_Follow-up_Debriefing Guide_21FEB2014.docx Form and Instruction
Mini-SSB_BEMT_21FEB2104.doc Mini-SSB_BEMT_21FEB2104 IC Document
Gen-Sub-Study-Form_21FEB2014.doc Gen-Sub-Study-Form_21FEB2014 IC Document
Attach1_BEMT Invite Letter_16JAN2014.docx Attach1_BEMT Invite Letter_16JAN2014 IC Document
Attach3_Reminder Email_3JAN2014.doc Attach3_Reminder Email_3JAN2014 IC Document
Mini-SSA_BEMT_3-7-2014.doc Mini-SSA_BEMT_3-7-2014 IC Document

Information Collection (IC) Details

IC Title:	Sub-study #10_Requirement Gathering for a Biobank Economic Modeling Tool (BEMT)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Survey Screenshots	Attach2_BEMT Survey Screenshots_10FEB2014.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	Follow-Up-Debriefing	Attach4-BEMT_Follow-up_Debriefing Guide_21FEB2014.docx		No	No	Printable Only

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records
Title: SORN #09-25-0156, "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"	FR Citation: 67 FR 60743

Number of Respondents: 450	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	450	450
Annual IC Time Burden (Hours)	752	752
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Mini-SSB_BEMT_21FEB2104	Mini-SSB_BEMT_21FEB2104.doc	02/24/2014
Gen-Sub-Study-Form_21FEB2014	Gen-Sub-Study-Form_21FEB2014.doc	02/24/2014
Attach1_BEMT Invite Letter_16JAN2014	Attach1_BEMT Invite Letter_16JAN2014.docx	02/24/2014
Attach3_Reminder Email_3JAN2014	Attach3_Reminder Email_3JAN2014.doc	02/24/2014
Mini-SSA_BEMT_3-7-2014	Mini-SSA_BEMT_3-7-2014.doc	03/07/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.