Generic Clearance Form Self-affirmation and affect

GENERIC SUB-STUDY SUBMISSION – 0925-0645

DATE OF REQUEST: December 9, 2014

SUB AGENCY (I/C): NIH/NCI/DCCPS

TITLE OF SUB-STUDY: Self-affirmation and affect

GENERIC CLEARANCE UNDER OMB #0925-0645 EXP. DATE: 11/30/2017

TOTAL ANNUAL BURDEN APPROVED: 2,000 hours

BURDEN APPROVED TO DATE: 0 hours

BURDEN FOR THIS REQUEST: 320 hours

ABSTRACT:

In this proposed sub-study, we plan to refine and validate a theory regarding the role of the self-related psychological that can influence how individuals respond to messages related to one’s own cancer risks. Using several conditions, a survey will be administered (Attachment A) that helps to refine a preliminary theory concerning the role of self-affirmation – affirming one’s self value – and recall of affective experiences in responding to health communications.

IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED? x YES _____NO_______N/A	IS PERSONALLY IDENTIFIABLE INFORMATION (PII) BEING COLLECTED? ______YES x NO_______N/A
OBLIGATION TO RESPOND: x VOLUNTARY ______ REQUIRED TO OBTAIN OR RETAIN BENEFITS ______ MANDATORY	TYPE OF COLLECTION/RESEARCH? _____ CUSTOMER SATISFACTION _____ USABILITY TESTING _____FOCUS GROUPS _____PRETESTING x FORMATIVE RESEARCH _____QUESTIONNAIRE DEVELOPMENT _____ OTHER: _________________________
HOW WILL THIS SURVEY BE OFFERED? x WEB SITE _____ TELEPHONE INTERVIEW _____ MAIL RESPONSE _____ IN PERSON INTERVIEW _____ OTHER: _________________________
CONTACT INFORMATION: NAME: Rebecca Ferrer TELEPHONE NUMBER: 240-276-6914 EMAIL ADDRESS: [email protected]