Multidisciplinary Treatment Planning (MTP) within the NCI Community Cancer Centers Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 Telephone Reminder	Form and Instruction	New	Available
Form 2 Survey Specific Tumor Site (Head & Neck, Breast, or Lung)	Form and Instruction	New	Available
SSB_NCCCP MTP_11-19-2013 - Rev Dec 11 2013.docx	Supporting Statement B	Uploaded 2014-01-22	Available
Att 7_OHSR Approval.pdf	Supplementary Document	Uploaded 2014-01-22	Available
Att 6_Privacy Act Memo_NCCCP.docm	Supplementary Document	Uploaded 2014-01-22	Available
Att 5_Consultants.docx	Supplementary Document	Uploaded 2014-01-22	Available
Att 4_Intro & Reminder Emails.docx	Supplementary Document	Uploaded 2014-01-22	Available
Att 3_Tumor Assign.docx	Supplementary Document	Uploaded 2014-01-22	Available
Att 2Cii_Lung Survey Sent Advance.pdf	Supplementary Document	Uploaded 2014-01-22	Available
Att 2Bii_Breast survey Sent Advance.pdf	Supplementary Document	Uploaded 2014-01-22	Available
Att 2Aii_Head&Neck Survey Sent Advance.pdf	Supplementary Document	Uploaded 2014-01-22	Available
Att 1_Background_9-5-2013.docx	Supplementary Document	Uploaded 2014-01-22	Available
Memo_ReviewRequest.docx	Supplementary Document	Uploaded 2014-01-22	Available
Cover Memo_9-5-2013.docx	Supplementary Document	Uploaded 2014-01-22	Available
SSA_REVISED_NCCCP MTP_3-28-2014.doc	Supporting Statement A	Uploaded 2014-03-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210225	Telephone Reminder	Form and Instruction	New
210224	Survey Specific Tumor Site (Head & Neck, Breast, or Lung)	Form and Instruction	New

ICR Details

OMB Control No: 0925-0693	ICR Reference No: 201401-0925-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No: 21341
Title: Multidisciplinary Treatment Planning (MTP) within the NCI Community Cancer Centers Program
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 with change	Conclusion Date: 04/07/2014
	Date Received in OIRA: 01/30/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2015	12 Months From Approved
Responses	42	0	0
Time Burden (Hours)	22	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a request for OMB to approve the new submission titled, "Multidisciplinary Treatment Planning (MTP) within the NCI Community Cancer Centers Program (NCCCP)" for one year. The aim of this data collection is to characterize how NCCCP hospitals define, structure, and implement multidisciplinary treatment planning (MTP), which initiates a coordinated approach to multidisciplinary care. The web-based, organizational survey will gather data on NCCCP hospitals' definitions and terms for multidisciplinary treatment planning, composition of provider teams, meeting procedures, and patient involvement in the process. Information collected from NCCCP hospitals will add to the knowledge being generated and provide the foundation for future research on multidisciplinary care approaches in cancer. A total of 21 hospitals participating in the NCCCP through June 2014 will be requested to complete the survey.

---

Authorizing Statute(s): US Code: 42 USC 285a-1 Name of Law: Public Health Service Act
   US Code: 42 USC 285a-2 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 65675	11/01/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 4478	01/28/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Survey Specific Tumor Site (Head & Neck, Breast, or Lung)	2, 1, 1	Breast Survey ,   Lung Survey ,   Head & Neck
Telephone Reminder	4	Telephone Reminder Script

---

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	42	0	0	42	0	0
Annual Time Burden (Hours)	22	0	0	22	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 new information collection.

---

Annual Cost to Federal Government: $7,952

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

---

Common Form ICR:  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:

(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: 01/30/2014

---