Evaluation of a Kidney Disease Education Program with Promotores in the Hispanic Community

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 In-depth Interview	Form and Instruction	New	Available
Form 2 Client pre-test, pot-test, and second post-tests for experimental control groups	Form and Instruction	New	Available
Form 2 Client pre-test, pot-test, and second post-tests for experimental control groups	Form and Instruction	New	Available
Form 1 Training pre-test post-test	Form and Instruction	New	Available
Attachment 7 Biographical Sketch.docx	Supplementary Document	Uploaded 2013-10-17	Available
Attachment 6 Applicability of the Privacy Act.docx	Supplementary Document	Uploaded 2013-10-17	Available
Attachment 5 Client Informed Consent.docx	Supplementary Document	Uploaded 2013-10-17	Available
Attachment 5 Client Informed Consent_SPA.DOCX	Supplementary Document	Uploaded 2013-10-17	Available
Attachment 5 Client Informed Consent_SPA.DOCX	Supplementary Document	Uploaded 2013-10-17	Available
Attachment 4 Client In-depth Interview Guide_SPA.docx	Supplementary Document	Uploaded 2013-10-17	Available
Attachment 3 Client Pre-test and Post-test Survey_SPA.DOCX	Supplementary Document	Uploaded 2013-10-17	Available
Attachment 2 Promotores In-depth Interview Guide_SPA.DOCX	Supplementary Document	Uploaded 2013-10-17	Available
Attachment 1 Promotores Training Pre-test and Post-test Survey SPA.docx	Supplementary Document	Uploaded 2013-10-17	Available
NKDEP Supporting Statement A Final 9-12EN.docx	Supporting Statement A	Uploaded 2013-10-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208916	Client Group (qualitative In-depth interview)	Form and Instruction	New	In-depth Interview
208915	Client Group (pre-test, post-test, second post-tests for experimental and control groups)	Form and Instruction	New	Client pre-test, pot-test, and second post-tests for experimental control groups
208914	Promotores (client pre-test, post-test, and second post-tests for experimenta and control groups)	Form and Instruction	New	Client pre-test, pot-test, and second post-tests for experimental control groups
208913	Promotores (training pre-test, post-test, and qualitative in-depth interview post client session)	Form and Instruction	New	Training pre-test post-test

ICR Details

OMB Control No: 0925-0688	ICR Reference No: 201310-0925-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No: 20658
Title: Evaluation of a Kidney Disease Education Program with Promotores in the Hispanic Community
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: Improperly submitted	Conclusion Date: 11/15/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/17/2013
Terms of Clearance: This collection must be resubmitted with a Supporting Statement Part B.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		06/30/2015
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Kidney Disease Education Program (NKDEP) of the National Institutes of Health is evaluating a community kidney disease education program developed for promotores (community health workers) who teach Hispanics about diabetes care. Data for a pilot project and national dissemination of the materials will be collected through pretest and posttest surveys and in-depth interviews to finalize the draft educational and training materials and to assess the partiicipants' change in knowledge and awareness and reported behavior and health status.

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Authorizing Statute(s): US Code: 42 USC 285c3 Name of Law: National Institute of Diabetes and Digestive and Kidney Diseases
  

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:
	78 FR 43214	07/19/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 59706	09/27/2013
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
Client Group (pre-test, post-test, second post-tests for experimental and control groups)	2	Client pre-test, pot-test, and second post-tests for experimental control groups
Client Group (qualitative In-depth interview)	3	In-depth Interview
Promotores (client pre-test, post-test, and second post-tests for experimenta and control groups)	2	Client pre-test, pot-test, and second post-tests for experimental control groups
Promotores (training pre-test, post-test, and qualitative in-depth interview post client session)	1	Training pre-test post-test

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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 ICR.

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Annual Cost to Federal Government: $30,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 10/17/2013

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