Health Information National Trends Survey 4 (HINTS 4) (NCI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Appendix B2 Short Survey	Form and Instruction	Modified	Available
Form 1 Appendix B2: Full Survey	Form and Instruction	Modified	Available
Form 1 Cycle 1 Survey Potential Questions	Form and Instruction	Modified	Available
Form 1 Cycle 1 Qx	Form and Instruction	Modified	Available
Form 2 List of Potential Questions for Cycle 2 Qx	Form and Instruction	Modified	Available
Form 4 List of Potential Questions for Cycle 4 Qx	Form and Instruction	Modified	Available
Form 4 Cycle 3 Instrument - Spanish	Form and Instruction	Modified	Available
Form 3 Cycle 3 Instrument - English	Form and Instruction	Modified	Available
Appendix E - HINTS Information Sheet.docx	Supplementary Document	Uploaded 2013-05-29	Available
Appendix B - List of Potential Items.pdf	Supplementary Document	Uploaded 2013-05-29	Available
HINTS memo Change Request Cycle 3.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2013-05-29	Available
Appendix A - HINTS Approvals.docx	Supplementary Document	Uploaded 2013-05-29	Available
Appendix K - Cover Letters in English.docx	Supplementary Document	Uploaded 2011-06-27	Available
Appendix L - Letters in Spanish.docx	Supplementary Document	Uploaded 2011-06-27	Available
Appendix L - Letters in Spanish.docx	Supplementary Document	Uploaded 2011-06-27	Available
Appendix K - Cover Letters in English.docx	Supplementary Document	Uploaded 2011-06-27	Available
Appendix L - Letters in Spanish.docx	Supplementary Document	Uploaded 2011-06-27	Available
Appendix K - Cover Letters in English.docx	Supplementary Document	Uploaded 2011-06-27	Available
Appendix K - Cover Letters in English-FINAL.docx	Supplementary Document	Uploaded 2011-09-30	Available
Appendix K - Cover Letters in English.docx	Supplementary Document	Uploaded 2011-06-27	Available
Appendix L - Letters in Spanish.docx	Supplementary Document	Uploaded 2011-06-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7462	Cycle 1 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Modified	Appendix B2 Short Survey
7462	Cycle 1 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Modified	Appendix B2: Full Survey
7462	Cycle 1 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Modified	Cycle 1 Survey Potential Questions
7462	Cycle 1 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Modified	Cycle 1 Qx
198508	Cycle 2 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Modified	List of Potential Questions for Cycle 2 Qx
181324	Cycle 4 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Modified	List of Potential Questions for Cycle 4 Qx
181323	Cycle 3 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Modified	Cycle 3 Instrument - Spanish
181323	Cycle 3 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Modified	Cycle 3 Instrument - English

ICR Details

OMB Control No: 0925-0538	ICR Reference No: 201306-0925-007
Status: Historical Active	Previous ICR Reference No: 201206-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No: 19700
Title: Health Information National Trends Survey 4 (HINTS 4) (NCI)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/14/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/20/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	10/31/2014	10/31/2014
Responses	14,066	0	14,066
Time Burden (Hours)	7,034	0	7,034
Cost Burden (Dollars)	0	0	0

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Abstract: HINTS provides NCI with a comprehensive assessment of the American public's current access to, and use of, information about cancer across the cancer care continuum from cancer prevention, early detection, diagnosis, treatment, and survivorship. The content of the survey focuses on understanding the degree to which members of the general population understand vital cancer prevention messages. More importantly, this NCI survey couples knowledge-related questions with inquiries into the communication channels through which understanding is being obtained, and assessment of cancer-related behavior. HINTS collects data using a stratified random sample of the non-institutionalized adult population (18+) in the 50 states and the District of Columbia. HINTS 4 methodology will consist of a mail survey conducted in 4 data collection cycles between 2011 and 2014.

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Authorizing Statute(s): US Code: 42 USC 412(285a-1) Name of Law: Public Health Service Act
   US Code: 42 USC 285(a) 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 22714	04/22/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 37356	06/27/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Cycle 1 Qx for Health Information National Trends Survey 4 (HINTS4)	1, 1, 1, 1	Cycle 1 Qx ,   Cycle 1 Survey Potential Questions ,   Appendix B2: Full Survey ,   Appendix B2 Short Survey
Cycle 2 Qx for Health Information National Trends Survey 4 (HINTS4)	2	List of Potential Questions for Cycle 2 Qx
Cycle 3 Qx for Health Information National Trends Survey 4 (HINTS4)	3, 4	Cycle 3 Instrument - English ,   Cycle 3 Instrument - Spanish
Cycle 4 Qx for Health Information National Trends Survey 4 (HINTS4)	4	List of Potential Questions for Cycle 4 Qx

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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	14,066	14,066	0	0	0	0
Annual Time Burden (Hours)	7,034	7,034	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $944,905

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: 06/20/2013

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