Focus Group Testing to Effectively Plan and Tailor Cancer Prevention and Control Communication Campaigns

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Recruitment Form - Disabilities	Form and Instruction	New	Available
Recruitment Form -Low SES	Form and Instruction	New	Available
Recruitment Form - Hispanic	Form and Instruction	New	Available
Focus Group Guide - Spanish	Form and Instruction	New	Available
Focus Group Guide	Form and Instruction	New	Available
Screener and Recruitment - Spanish	Form and Instruction	New	Available
Screener and Recruitment	Form and Instruction	New	Available
Form 0920-0800 J - Screening Instrument for Other Young Women	Form and Instruction	New	Available
Form 0920-0800 I - Screening Instrument for African American Young Women	Form and Instruction	New	Available
Form 0920-0800 H - Screening Instrument for Ashkenazi Jewish Young Women	Form and Instruction	New	Available
Form 0920-0800 F2 - Materials for Testing_Other (Family History)_4 09 2015	Form and Instruction	New	Available
Form 0920-0800 F1 - Discussion Guide Other (Family History)_04 09 2015	Form and Instruction	New	Available
Form 0920-0800 E1 - Discussion Guide for AA (No Family History)_04 09 2015	Form and Instruction	New	Available
Form 0920-0800 D2 - Materials for Testing_AA (Family History)_4 09 2015	Form and Instruction	New	Available
Form 0920-0800 D1 - Discussion Guide for AA (Family History)_04 09 2015	Form and Instruction	New	Available
Form 0920-0800 C2 - Materials for Testing_AJ (No Family History)_4 09 2015	Form and Instruction	New	Available
Form 0920-0800 C1 - Discussion Guide for AJ (No Family History)_04 09 2015	Form and Instruction	New	Available
Form 0920-0800 B2 - Materials for Testing_AJ (Family History)_4 09 2015	Form and Instruction	New	Available
App E. Reference Questions 6 27 2014.doc	Supplementary Document	Uploaded 2014-08-25	Available
App D. Example Consent Form.doc	Supplementary Document	Uploaded 2014-08-25	Available
App C. Reference Questions for Screening_7 31 2014.doc	Supplementary Document	Uploaded 2014-08-25	Available
App B1. 60-day FRN 6 25 2014.pdf	Supplementary Document	Uploaded 2014-08-25	Available
0920-0800 SS Part B 6 27 2014.doc	Supporting Statement B	Uploaded 2014-08-25	Available
0920-0800 SS Part A_7 31 2014.doc	Supporting Statement A	Uploaded 2014-08-25	Available
App F. 684 Form Public Health Practice.pdf	Supplementary Document	Uploaded 2011-10-19	Available
App A2. Johannas Law.pdf	Supplementary Document	Uploaded 2011-10-19	Available
App A1. PHSA.doc	Supplementary Document	Uploaded 2011-10-19	Available
App D. Consent Form 8.2.11.doc	Supplementary Document	Uploaded 2011-10-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
226204	Focus Group Testing to Effectively Plan and Tailor "Bring Your Brave" Communication Campaign Messages	Other-WORD	New
226107	Assessing Satisfaction with Technical Assistance (TA) Provided to Racial and Ethnic Approaches to Community Health (REACH) Awardees	Other-WORD	New
223243	Formative Research Legionella	Other-WORD	New
219428	Focus Groups Assessing the Uptake and Effectiveness of Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign Materials	Form and Instruction	New	Recruitment Form - Disabilities
219428	Focus Groups Assessing the Uptake and Effectiveness of Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign Materials	Form and Instruction	New	Recruitment Form -Low SES
219428	Focus Groups Assessing the Uptake and Effectiveness of Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign Materials	Form and Instruction	New	Recruitment Form - Hispanic
219428	Focus Groups Assessing the Uptake and Effectiveness of Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign Materials	Instruction	New
217174	2015 Focus Group Testing with General Public	Form and Instruction	New	Focus Group Guide - Spanish
217174	2015 Focus Group Testing with General Public	Form and Instruction	New	Focus Group Guide
217174	2015 Focus Group Testing with General Public	Form and Instruction	New	Screener and Recruitment - Spanish
217174	2015 Focus Group Testing with General Public	Form and Instruction	New	Screener and Recruitment
216348	Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Form and Instruction	New	J - Screening Instrument for Other Young Women
216348	Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Form and Instruction	New	I - Screening Instrument for African American Young Women
216348	Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Form and Instruction	New	H - Screening Instrument for Ashkenazi Jewish Young Women
216348	Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Form and Instruction	New	F2 - Materials for Testing_Other (Family History)_4 09 2015
216348	Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Form and Instruction	New	F1 - Discussion Guide Other (Family History)_04 09 2015
216348	Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Form and Instruction	New	E1 - Discussion Guide for AA (No Family History)_04 09 2015
216348	Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Form and Instruction	New	D2 - Materials for Testing_AA (Family History)_4 09 2015
216348	Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Form and Instruction	New	D1 - Discussion Guide for AA (Family History)_04 09 2015
216348	Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Form and Instruction	New	C2 - Materials for Testing_AJ (No Family History)_4 09 2015
216348	Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Form and Instruction	New	C1 - Discussion Guide for AJ (No Family History)_04 09 2015
216348	Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Form and Instruction	New	B2 - Materials for Testing_AJ (Family History)_4 09 2015
216348	Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	Instruction	New

ICR Details

OMB Control No: 0920-0800	ICR Reference No: 201408-0920-009
Status: Historical Active	Previous ICR Reference No: 201111-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Focus Group Testing to Effectively Plan and Tailor Cancer Prevention and Control Communication Campaigns
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/08/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/12/2014
Terms of Clearance: Previous terms of clearance continue: This generic clearance for HHS/CDC Focus Group Testing to Effectively Plan and Tailor Cancer Prevention and Control Communication Campaigns is approved under the following conditions: 1) HHS/CDC shall use the generic clearance to collect general public and health care professionals data (via focus groups) where the agency seeks to gather information for general service improvement, not for publication or for the purpose of informing significant policy or resource allocation decisions. 2) Focus groups should be of limited size and scope. 3) For individual focus groups, HHS/CDC shall submit a generic IC in ROCIS along with an abbreviated supporting statement in the template agreed to by OMB and HHS/CDC. This statement shall include all relevant information, including a statement of need, intended use of information, description of respondents, information collection procedures, expected response rate, justification for incentive, and estimated burden. 4) OMB will aim to respond with clearance or questions within 10 working days.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved	12/31/2014
Responses	7,200	0	2,592
Time Burden (Hours)	5,040	0	1,814
Cost Burden (Dollars)	81,934	0	52,843

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Abstract: CDC conducts focus groups and interviews to collect the information needed to plan and tailor communication campaigns for colorectal cancer, gynecologic cancer, and other cancers. These efforts are supported by a generic clearance dedicated to formative research with the general public, health care professionals, and other targeted audiences.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
   US Code: 42 USC 247b-17 Name of Law: Gynecologic Cancer Education and Awareness Act, Johanna's Law
  

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:
	79 FR 36065	06/25/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 52011	09/02/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
2015 Focus Group Testing with General Public	none, none, none, none	Screener and Recruitment ,   Screener and Recruitment - Spanish ,   Focus Group Guide ,   Focus Group Guide - Spanish
Assessing Satisfaction with Technical Assistance (TA) Provided to Racial and Ethnic Approaches to Community Health (REACH) Awardees
Focus Group Testing to Effectively Plan and Tailor "Bring Your Brave" Communication Campaign Messages
Focus Group Testing to Effectively Plan and Tailor a Communication Campaign about Young Women and Breast Cancer	0920-0800, 0920-0800, 0920-0800, 0920-0800, 0920-0800, 0920-0800, 0920-0800, 0920-0800, 0920-0800, 0920-0800, 0920-0800	B2 - Materials for Testing_AJ (Family History)_4 09 2015 ,   C1 - Discussion Guide for AJ (No Family History)_04 09 2015 ,   C2 - Materials for Testing_AJ (No Family History)_4 09 2015 ,   D1 - Discussion Guide for AA (Family History)_04 09 2015 ,   D2 - Materials for Testing_AA (Family History)_4 09 2015 ,   E1 - Discussion Guide for AA (No Family History)_04 09 2015 ,   F1 - Discussion Guide Other (Family History)_04 09 2015 ,   F2 - Materials for Testing_Other (Family History)_4 09 2015 ,   H - Screening Instrument for Ashkenazi Jewish Young Women ,   I - Screening Instrument for African American Young Women ,   J - Screening Instrument for Other Young Women
Focus Groups Assessing the Uptake and Effectiveness of Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign Materials	NA, NA, NA	Recruitment Form - Hispanic ,   Recruitment Form -Low SES ,   Recruitment Form - Disabilities
Formative Research Legionella

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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	7,200	2,592	0	4,608	0	0
Annual Time Burden (Hours)	5,040	1,814	0	3,226	0	0
Annual Cost Burden (Dollars)	81,934	52,843	0	29,091	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 an Extension ICR with a small reduction in Burden; the numbers previously presented were not for three years of clearance.

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Annual Cost to Federal Government: $482,000

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? 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: 09/12/2014

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