Experiences with the Implementation and Outcomes of Policy and Environmental Cancer Control Interventions

Forms and Documents

Document Name	Status
Form 0920- CCC Partners TA Provider Focus Group Guide Form and Instruction	New
Form 0920- CCC Partners Coalition Survey Form and Instruction	New
Form 0920- CCC Partners Key Informant Interview Guide Form and Instruction	New
Form 0920- CCC Partners Key Informant Recruitment/Scheduling Form and Instruction	New
Form 0920- CCC Staff Key Informant Recruitment/Scheduling Form and Instruction	New
Form 0920- CCC Staff Key Informant Selection Form and Instruction	New
Form 0920- CCC Program Director Web Survey Questionnaire Form and Instruction	New
13PR Part_B_01 16 2014.docx Supporting Statement B	2014-02-10
Att D5_ Informed_Consent_for_Key_Informant_Interview_1_23_14 (3).docx Supplementary Document	2014-02-11
Att D2_ Initial_Site_Contact_Email_10_29_13.docx Supplementary Document	2014-02-11
Att G_Battelle IRB Approval Letter_10_29_13.pdf Supplementary Document	2014-02-11
Att A _Authorizing_Legislation.docx Supplementary Document	2014-02-11
Att B2_Summary of Public Comments.doc Supplementary Document	2014-02-10
Att E2_TA Provider Focus_Group_Invitation_11_01_13.docx Supplementary Document	2014-02-11
Att F5_Coalition_Survey_Thank You E-Mail.docx Supplementary Document	2014-02-11
Att F4_Coalition_Survey_Reminder E-Mail.docx Supplementary Document	2014-02-11
Att F3_Coalition_Survey_Recruitment E-Mail.docx Supplementary Document	2014-02-11
Att F2_Coalition_Survey_Advance E-Mail.docx Supplementary Document	2014-02-11
Att D1_Key_Informant_Interview_11_01_13.docx Supplementary Document	2014-02-11
Att D1_Key_Informant_Interview_11_01_13.docx Supplementary Document	2014-02-11
Att D1_Key_Informant_Interview_11_01_13.docx Supplementary Document	2014-02-11
Att C5_ Program_Director_Thankyou_E-Mail_10_29_13.docx Supplementary Document	2014-02-11
Att C2 _Program_Director_Advance_Letter_10_29_13.docx Supplementary Document	2014-02-11
Att C3_Program_Director_Advance_E-Mail_10_29_13.docx Supplementary Document	2014-02-11
Att C4_ Program_Director_Reminder_E-Mail_10_29_13.docx Supplementary Document	2014-02-11
13PR Part_A_01 16 2014.docx Supporting Statement A	2014-02-10

IC Document Collections

IC ID	Document Title	Status
210390	CCC Partners TA Provider Focus Group Guide Form and Instruction	New
210389	CCC Partners Coalition Survey Form and Instruction	New
210388	CCC Partners Key Informant Interview Guide Form and Instruction	New
210387	CCC Staff Key Informant Interview Guide Instruction	New
210386	CCC Partners Key Informant Recruitment/Scheduling Form and Instruction	New
210385	CCC Staff Key Informant Recruitment/Scheduling Form and Instruction	New
210384	CCC Staff Key Informant Selection Form and Instruction	New
210383	CCC Program Director Web Survey Questionnaire Form and Instruction	New

ICR Details

OMB Control No: 0920-1016	ICR Reference No: 201402-0920-012
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 21426
Title: Experiences with the Implementation and Outcomes of Policy and Environmental Cancer Control Interventions
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 without change	Conclusion Date: 05/02/2014
	Date Received in OIRA: 02/18/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2017	36 Months From Approved
Responses	267	0	0
Time Burden (Hours)	161	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is a new ICR, CDC plans to conduct a three-year mixed-methods study to collect information about the experiences and outcomes of state-based comprehensive cancer control (ccc) programs that are implementing policy, system and environmental (PSE) change strategies to address cancer prevention and control. Information will be collected from all 65 funded CCC programs, a subset of 13 CCC programs that recieved additional funding to enhance their PSE change strategies, and program partners and coalition members.

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Authorizing Statute(s): US Code: 42 USC 301 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:
	78 FR 67	03/08/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 9054	02/07/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 8

IC Title	Form No.	Form Name
CCC Program Director Web Survey Questionnaire	0920-	Att C1a _Program_Director_Web_Survey_10_29_13
CCC Staff Key Informant Selection	0920-	Att D3_Key_Informant_Selection_10_29_13
CCC Staff Key Informant Recruitment/Scheduling	0920-	Att D4_Key_Informant_Recruitment Scheduling
CCC Partners Key Informant Recruitment/Scheduling	0920-	Att D4_Key_Informant_Recruitment Scheduling
CCC Staff Key Informant Interview Guide
CCC Partners Key Informant Interview Guide	0920-	Att D4_Key_Informant_Recruitment Scheduling
CCC Partners Coalition Survey	0920-	Att F1_Coalition_Survey
CCC Partners TA Provider Focus Group Guide	0920-	Att E1_TA_Provider_Focus_Group_Guide

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ICR Summary 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	267	0	0	267	0	0
Annual Time Burden (Hours)	161	0	0	161	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 a new information collection request that will supplement and complement existing sources of information including OMB number 0920-0971 exp. 3/31/2016.

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Annual Cost to Federal Government: $355,470

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? Yes

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: 02/18/2014

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