State and Community Tobacco Control (SCTC) Research Initiative Evaluation (NCI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 PI/CO-PI TELEPHONE INTERVIEW GUIDE	Form	Unchanged	Available
Form 4 TELEPHONE SCRIPT TO SCHEDULE TELEPHONE INTERVIEW	Form	Unchanged	Available
Form 1 EXPERT PANEL INFORMED CONSENT	Form and Instruction	Modified	Available
Form 8 PI/CO-PI EXPERT PANEL MODERATOR GUIDE	Form and Instruction	Unchanged	Available
Form 7 COORDINATING CENTER TELEPHONE INTERVIEW GUIDE	Form	Unchanged	Available
Form 6 WORKING GROUP TELEPHONE INTERVIEW GUIDE	Form	Unchanged	Available
Form 5 PILOT PROJECT TELEPHONE INTERVIEW GUIDE	Form	Unchanged	Available
Form 4 TELEPHONE SCRIPT TO SCHEDULE TELEPHONE INTERVIEW	Form	Unchanged	Available
Form 3 AFFILIATED PARTNER TELEPHONE INTERVIEW GUIDE	Form	Unchanged	Available
Form 2 AFFILIATED PARTNERS WEB SURVEY	Form and Instruction	Unchanged	Available
Form 1 SCTC SCIENTISTS WEB SURVEY	Form and Instruction	Unchanged	Available
Supporting Statement B SCTC 9-2-14.docx	Supporting Statement B	Uploaded 2014-10-13	Available
Supporting Statement A SCTC 10-9-14.docx	Supporting Statement A	Uploaded 2014-10-13	Available
Attachment 28.Email Confirmation for Telephone Interview.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 26.Email Follow-up Reminder to Schedule Interview.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 25.Telephone Follow-up Reminder Telephone Interview.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 24.Telephone Follow-up Reminder Web Survey.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 23.Email Reminder Telephone Interview.AP.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 22.Email Reminder Telephone Interview.SCTC Scientisits.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 21.Email Reminder Web Survey.AP.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 20.Email Reminder Web Survey.SCTC Scientists.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 19.Email Invitation Letter Expert Panel.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 18.Email Invitation Letter Telephone Interview.AP.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 17.Email Invitation Letter Telephone Interview.SCTC Scientisits.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 16.Email Invitation Letter Web Survey.AP.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 15.Email Invitation Letter Web Survey.SCTC Scientists.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 14.Email Study Announcement.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 12. Privacy Act Memo.pdf	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 11.Individuals Consulted in Development of Conceptual Model.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 10.Privacy Impact Assessment.9-2-14.docx	Supplementary Document	Uploaded 2014-10-09	Available
Attachment 13.IRB Approval Letters.9-3-14.docx	Supplementary Document	Uploaded 2014-10-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213453	PI/CO-PI TELEPHONE INTERVIEW GUIDE	Form	Unchanged	PI/CO-PI TELEPHONE INTERVIEW GUIDE
213452	TELEPHONE SCRIPT TO SCHEDULE TELEPHONE INTERVIEW	Form	Unchanged	TELEPHONE SCRIPT TO SCHEDULE TELEPHONE INTERVIEW
213451	EXPERT PANEL INFORMED CONSENT	Form and Instruction	Modified	EXPERT PANEL INFORMED CONSENT
213450	PI/CO-PI EXPERT PANEL MODERATOR GUIDE	Form and Instruction	Unchanged	PI/CO-PI EXPERT PANEL MODERATOR GUIDE
213449	COORDINATING CENTER TELEPHONE INTERVIEW GUIDE	Form	Unchanged	COORDINATING CENTER TELEPHONE INTERVIEW GUIDE
213448	WORKING GROUP TELEPHONE INTERVIEW GUIDE	Form	Unchanged	WORKING GROUP TELEPHONE INTERVIEW GUIDE
213446	PILOT PROJECT TELEPHONE INTERVIEW GUIDE	Form	Unchanged	PILOT PROJECT TELEPHONE INTERVIEW GUIDE
213445	TELEPHONE SCRIPT TO SCHEDULE TELEPHONE INTERVIEW	Form	Unchanged	TELEPHONE SCRIPT TO SCHEDULE TELEPHONE INTERVIEW
213444	AFFILIATED PARTNER TELEPHONE INTERVIEW GUIDE	Form	Unchanged	AFFILIATED PARTNER TELEPHONE INTERVIEW GUIDE
213443	AFFILIATED PARTNERS WEB SURVEY	Form and Instruction	Unchanged	AFFILIATED PARTNERS WEB SURVEY
213442	SCTC Scientist	Form and Instruction	Unchanged	SCTC SCIENTISTS WEB SURVEY

ICR Details

OMB Control No: 0925-0707	ICR Reference No: 201410-0925-003
Status: Historical Active	Previous ICR Reference No: 201410-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: State and Community Tobacco Control (SCTC) Research Initiative Evaluation (NCI)
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: 11/13/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/15/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2016	24 Months From Approved
Responses	236	0	0
Time Burden (Hours)	112	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request to approve a new collection titled "State and Community Tobacco Control Research Initiative Evaluation" (NCI) for 2 years. This 5-year (FY 2012-2016), $46 million ($9.2 million/year) program resides within the Tobacco Control Research Branch in the Behavioral Research Program of the Division of Cancer Control and Population Sciences. The program targets four high-priority tobacco control research areas at the state and community level in the United States: (1) Secondhand smoke policies, (2) Tobacco tax and pricing policies, (3) Mass media countermeasures and community and social norms, and (4) Tobacco industry practices. The initiative supports innovative research to yield rapid and actionable findings for state and community tobacco control programs. The NCI is undertaking an evaluation to assess the dissemination, implementation, and community collaboration processes of the SCTC grantees and their respective state and community partners and stakeholders. The evaluation will utilize archival grant project data and archival data collected from the scientists in the first two years of the initiative. The evaluation will also collect new data to: 1) determine relationships, interactions, and connectedness among network partnerships over time and with policy makers; 2) assess the utility of research tools, interventions, products, and findings from the perspective of key tobacco control stakeholders; and 3) determine key indicators for broad adoption of research products. Results will address research-to-practice gaps by providing a critical window into the process of disseminating evidence-based research tools, products, and science findings in community public health settings. Intended audiences include staff at NIH Institutes and Centers interested in supporting translation/dissemination and implementation science.

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Authorizing Statute(s): US Code: 42 USC 285a-1 Name of Law: The 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:
	79 FR 32742	06/06/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 56818	09/23/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 11

table that charts list of burden

IC Title	Form No.	Form Name
AFFILIATED PARTNER TELEPHONE INTERVIEW GUIDE	3	AFFILIATED PARTNER TELEPHONE INTERVIEW GUIDE
AFFILIATED PARTNERS WEB SURVEY	2	AFFILIATED PARTNERS WEB SURVEY
COORDINATING CENTER TELEPHONE INTERVIEW GUIDE	7	COORDINATING CENTER TELEPHONE INTERVIEW GUIDE
EXPERT PANEL INFORMED CONSENT	1	EXPERT PANEL INFORMED CONSENT
PI/CO-PI EXPERT PANEL MODERATOR GUIDE	8	PI/CO-PI EXPERT PANEL MODERATOR GUIDE
PI/CO-PI TELEPHONE INTERVIEW GUIDE	3	PI/CO-PI TELEPHONE INTERVIEW GUIDE
PILOT PROJECT TELEPHONE INTERVIEW GUIDE	5	PILOT PROJECT TELEPHONE INTERVIEW GUIDE
SCTC Scientist	1	SCTC SCIENTISTS WEB SURVEY
TELEPHONE SCRIPT TO SCHEDULE TELEPHONE INTERVIEW	4	TELEPHONE SCRIPT TO SCHEDULE TELEPHONE INTERVIEW
TELEPHONE SCRIPT TO SCHEDULE TELEPHONE INTERVIEW	4	TELEPHONE SCRIPT TO SCHEDULE TELEPHONE INTERVIEW
WORKING GROUP TELEPHONE INTERVIEW GUIDE	6	WORKING GROUP TELEPHONE INTERVIEW GUIDE

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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	236	0	0	236	0	0
Annual Time Burden (Hours)	112	0	0	112	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 ICR.

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Annual Cost to Federal Government: $229,930

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: 10/15/2014

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