Genomics and Society Public Surveys (NHGRI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Exploring Our Identity Genetics Ancestry and Race	Form and Instruction	Modified	Available
Form 1 Will Genome Sequence Information Change How you View Yourself	Form and Instruction	Modified	Available
Form 1 CelebritiesPrescrition Drugs and Salmon	Form and Instruction	Modified	Available
Form 1 Kids Genes and Health	Form and Instruction	Modified	Available
Form 1 Could Your Genes Predict your Weight	Form and Instruction	Modified	Available
Form 1 Health and Genetics from YOUR Point of View	Form and Instruction	Modified	Available
Form 1 Map Your Social Network	Form and Instruction	Modified	Available
Form 1 Text Responses and Demographics	Form and Instruction	Modified	Available
StatementB_Final.pdf	Supporting Statement B	Uploaded 2014-03-24	Available
Attach 22 IRB Approval Letter.pdf	Supplementary Document	Uploaded 2014-03-24	Available
Attach 20 Poll Everywhere Privacy Policy.pdf	Supplementary Document	Uploaded 2014-03-24	Available
Attach 21 Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2014-03-24	Available
Attach 1 Flow Chart of Survey Procedure.pdf	Supplementary Document	Uploaded 2014-03-24	Available
Attach 4 Consent for Online Surveys.pdf	Supplementary Document	Uploaded 2014-03-24	Available
Attach 18. Survey Exploring Our Identity Genetics, Ancestry, and Race-Bonham.pdf	Supplementary Document	Uploaded 2014-03-24	Available
Attach 16 Survey Will Genome Information Change How You View Yourself-Biesecker.pdf	Supplementary Document	Uploaded 2014-03-24	Available
Attach 14. Celebrities, Prescription Drugs & Salmon-McBride.pdf	Supplementary Document	Uploaded 2014-03-24	Available
Attach 12. Survey Kids, Genes, and Health-Shaw.pdf	Supplementary Document	Uploaded 2014-03-24	Available
Attach 10. Survey Could Your Genes Predict Your Weight-Persky.pdf	Supplementary Document	Uploaded 2014-03-24	Available
Attach 8. Survey Health and Genetics from YOUR Point of View-Klein.pdf	Supplementary Document	Uploaded 2014-03-24	Available
Attach 6. Survey Map Your Social Network-Koehly.pdf	Supplementary Document	Uploaded 2014-03-24	Available
0925-NEW Supporting StatementA_27June2014.doc	Supporting Statement A	Uploaded 2014-06-30	Source copy available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209623	Exploring Our Identity Genetics Ancestry and Race	Form and Instruction	Modified
209622	Will Genome Sequence Information Change How you View Yourself	Form and Instruction	Modified
209621	CelebritiesPrescrition Drugs and Salmon	Form and Instruction	Modified
209620	Kids Genes and Health	Form and Instruction	Modified
209619	Could Your Genes Predict your Weight	Form and Instruction	Modified
209618	Health and Genetics from YOUR Point of View	Form and Instruction	Modified
209617	Map Your Social Network	Form and Instruction	Modified
209616	Text Responses and Demographics	Form and Instruction	Modified

ICR Details

OMB Control No: 0925-0700	ICR Reference No: 201403-0925-011
Status: Historical Active	Previous ICR Reference No: 201312-0925-004
Agency/Subagency: HHS/NIH	Agency Tracking No: 21600
Title: Genomics and Society Public Surveys (NHGRI)
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: 07/03/2014
	Date Received in OIRA: 03/28/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved
Responses	438,000	0	0
Time Burden (Hours)	91,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Human Genome Research Institute's (NHGRI), National Institutes of Health (NIH), strategic plan puts a strong focus on understanding more fully the societal implications of recent genomic advances. Currently, there is limited knowledge about the public's view regarding genomics and society. The Smithsonian National Museum of Natural History exhibit, "Genome: Unlocking Life's Code", provides a unique opportunity to obtain the perspective of the public about the behavioral and social issues related to genomics. The collection of information activities set forth herein would be conducted under the authorities granted in the Public Health Service Act, Title 42 USC 285s. This project will help to fulfill the mission of the Institute; specifically, to obtain knowledge about the public's views regarding genomics and society. This information will inform future NHGRI DIR research and community education programs that promote genomic awareness and disease prevention.

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Authorizing Statute(s): US Code: 42 USC 285s 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 24427	04/25/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 55083	09/09/2013
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
CelebritiesPrescrition Drugs and Salmon	1	Screenshot: Celebrities, Prescription Drugs & Salmon
Will Genome Sequence Information Change How you View Yourself	1	Screenshot: Will Genome Information Change How You View Yourself?
Exploring Our Identity Genetics Ancestry and Race	1	Screenshot: Exploring Our Identity: Genetics, Ancestry, and Race
Text Responses and Demographics	1, 2	Text Responses ,   Demographic Questions
Map Your Social Network	1	Screenshot: Map Your Social Network
Health and Genetics from YOUR Point of View	1	Screenshot: Health and Genetics from YOUR Point of View
Could Your Genes Predict your Weight	1	Screenshot: Could Your Genes Predict Your Weight?
Kids Genes and Health	1	Screenshot: Kids, Genes, and Health

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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	438,000	0	0	438,000	0	0
Annual Time Burden (Hours)	91,000	0	0	91,000	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 collection of information.

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Annual Cost to Federal Government: $196,000

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: 03/28/2014

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