Health Information National Trends Survey 4 (HINTS 4) (NCI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Appendix B2 Short Survey	Form and Instruction	Removed	Repair queued
Form 1 Appendix B2: Full Survey	Form and Instruction	Removed	Available
Form 1 Cycle 1 Survey Potential Questions	Form and Instruction	Removed	Available
Form 1 Cycle 1 Qx	Form and Instruction	Removed	Source copy available
Form 1 B1- Instrument in English	Form and Instruction	New	Available
Form 2 List of Potential Questions for Cycle 2 Qx	Form and Instruction	Removed	Available
Form 3 Spanish Version of Instrument for Cycle 4	Form and Instruction	Removed	Available
Form 2 English Version of Instrument for Cycle 4	Form and Instruction	Removed	Available
Form 4 List of Potential Questions for Cycle 4 Qx	Form and Instruction	Removed	Available
Form 4 Cycle 3 Instrument - Spanish	Form and Instruction	Removed	Available
Form 3 Cycle 3 Instrument - English	Form and Instruction	Removed	Available
Tracking Public Comments for 60-Day FRN-updatedFeb2015.doc	Public Comments	Uploaded 2014-12-03	Repair queued
M - References.docx	Supplementary Document	Uploaded 2015-02-18	Available
L - New Questions to HINTS.docx	Supplementary Document	Uploaded 2015-02-18	Available
K - Letters in Spanish.pdf	Supplementary Document	Uploaded 2015-02-18	Available
J - Letters in English.pdf	Supplementary Document	Uploaded 2015-02-18	Available
SSB HINTS revisions 11-4-14.docx	Supporting Statement B	Uploaded 2015-02-18	Available
I - IRB Approval Letters.pdf	Supplementary Document	Uploaded 2015-02-18	Available
H - Westat Confidentiality Pledge.pdf	Supplementary Document	Uploaded 2015-02-18	Available
G - Privacy Act Memo.pdf	Supplementary Document	Uploaded 2015-02-18	Available
F - List of people consulted.docx	Supplementary Document	Uploaded 2015-02-18	Available
E - Comparison of Items.xlsx	Supplementary Document	Uploaded 2015-02-18	Available
D - Privacy Act Assessment.pdf	Supplementary Document	Uploaded 2015-02-18	Available
C - Publications.docx	Supplementary Document	Uploaded 2015-02-18	Available
A - HistoryHints.doc	Supplementary Document	Uploaded 2015-02-18	Available
SSA HINTS 02 03 2015docx.docx	Supporting Statement A	Uploaded 2015-02-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7462	Cycle 1 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Removed	Appendix B2 Short Survey
7462	Cycle 1 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Removed	Appendix B2: Full Survey
7462	Cycle 1 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Removed	Cycle 1 Survey Potential Questions
7462	Cycle 1 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Removed	Cycle 1 Qx
215033	Health Information National Trends Survey	Form and Instruction	New	B1- Instrument in English
198508	Cycle 2 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Removed	List of Potential Questions for Cycle 2 Qx
181324	Cycle 4 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Removed	Spanish Version of Instrument for Cycle 4
181324	Cycle 4 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Removed	English Version of Instrument for Cycle 4
181324	Cycle 4 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Removed	List of Potential Questions for Cycle 4 Qx
181323	Cycle 3 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Removed	Cycle 3 Instrument - Spanish
181323	Cycle 3 Qx for Health Information National Trends Survey 4 (HINTS4)	Form and Instruction	Removed	Cycle 3 Instrument - English

ICR Details

OMB Control No: 0925-0538	ICR Reference No: 201502-0925-003
Status: Historical Active	Previous ICR Reference No: 201407-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No: 19700
Title: Health Information National Trends Survey 4 (HINTS 4) (NCI)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/10/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/23/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2016	12 Months From Approved	10/31/2014
Responses	4,318	0	14,066
Time Burden (Hours)	2,159	0	7,034
Cost Burden (Dollars)	0	0	0

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Abstract: NCI has partnered with the FDA to develop this round of HINTS which will include assessing the public's knowledge of medical devices, communications related to product recalls, nutritional supplement labeling, risk perceptions about new tobacco products, perceptions of tobacco product harm, and tobacco product claims and labels. This HINTS survey will couple knowledge-related questions with inquiries into the communication channels through which understanding is being obtained, and assessment of both FDA-regulated materials (e.g., tobacco, supplements) and cancer knowledge and risk. This survey will extend the information collected and priorities from other rounds of HINTS which has been to provide a comprehensive assessment of the American public's current access to, and use of, information about cancer across the cancer care continuum from cancer prevention, early detection, diagnosis, treatment, and survivorship.

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Authorizing Statute(s): US Code: 42 USC 412(285a-1) Name of Law: Public Health Service Act
   US Code: 42 USC 285(a) 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:
	79 FR 72003	12/04/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 33	02/19/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Cycle 1 Qx for Health Information National Trends Survey 4 (HINTS4)	1, 1, 1, 1	Cycle 1 Qx ,   Cycle 1 Survey Potential Questions ,   Appendix B2: Full Survey ,   Appendix B2 Short Survey
Cycle 2 Qx for Health Information National Trends Survey 4 (HINTS4)	2	List of Potential Questions for Cycle 2 Qx
Cycle 3 Qx for Health Information National Trends Survey 4 (HINTS4)	3, 4	Cycle 3 Instrument - English ,   Cycle 3 Instrument - Spanish
Cycle 4 Qx for Health Information National Trends Survey 4 (HINTS4)	4, 2, 3	List of Potential Questions for Cycle 4 Qx ,   English Version of Instrument for Cycle 4 ,   Spanish Version of Instrument for Cycle 4
Health Information National Trends Survey	1	B1- Instrument in English

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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	4,318	14,066	0	-9,748	0	0
Annual Time Burden (Hours)	2,159	7,034	0	-4,875	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: reinstatement due to changes

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Annual Cost to Federal Government: $1,069,204

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: 02/23/2015

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