Questionnaire Cognitive Interviewing and Pretesting (NCI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 Attachment F Interview Protocol	Form and Instruction	New	Available
Form 3 Attachment E Questionnaire Content	Form and Instruction	New	Available
Form 2 Attachment D Consent Form	Form and Instruction	New	Available
Form 1 Attachment C Screening Questionnaire	Form and Instruction	New	Available
Form 2 Appendix B Screenshots Condition 2	Form and Instruction	New	Available
Form 1 Appendix A Screenshots Condition 1	Form and Instruction	New	Available
Form 4 Appendix D Final Cognitive Probes	Form and Instruction	Unchanged	Available
Form 3 Appendix C Final Random Order	Form and Instruction	Unchanged	Available
Form 2 Appendix B Final Walking Behaviors First	Form and Instruction	Unchanged	Available
Form 1 Appendix A Final Walking Environment First	Form and Instruction	Unchanged	Available
Revised Change Request Memo 0925-0589.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-11-06	Available
Attach 6F_Consent_031914.docx	Supplementary Document	Uploaded 2014-04-28	Available
Attach 6E_VR12 Legacy Instrument.docx	Supplementary Document	Uploaded 2014-04-28	Available
Attach 6D_IRB Review.pdf	Supplementary Document	Uploaded 2014-04-28	Available
Attach 6C_ CAT Instrument Screen Shot.pdf	Supplementary Document	Uploaded 2014-04-28	Available
Attach 6B_All PF CAT Items_NIH revised.doc	Supplementary Document	Uploaded 2014-04-28	Available
Attach 6A_All Behavioral Health CAT Items_NIH Revised.doc	Supplementary Document	Uploaded 2014-04-28	Available
Attach 6_Sub-study1_miniSSB_Test_Retest-NIH-CC.docx	Supplementary Document	Uploaded 2014-04-28	Available
Attach 6_Sub-study1_miniSSA_Test_Retest-NIH-CC.docx	Supplementary Document	Uploaded 2014-04-28	Available
Attach 5_Consultants.doc	Supplementary Document	Uploaded 2014-04-28	Available
Attach 4_Privacy Act Memo.pdf	Supplementary Document	Uploaded 2014-04-28	Available
Attach 3_Cognitive Interviewing.doc	Supplementary Document	Uploaded 2014-04-28	Available
Attach 2_Approved&Pending Review GEN ICs.doc	Supplementary Document	Uploaded 2014-04-28	Available
Attach 1_Background&History.doc	Supplementary Document	Uploaded 2014-04-28	Available
SSB_0925-0589 4-11-2014_Cycle3.doc	Supporting Statement B	Uploaded 2014-04-28	Available
REVISED SSA_0925-0589 OMB Passbacks 6 27 14.docx	Supporting Statement A	Uploaded 2014-07-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
221003	HINTS 5 Cognitive Testing	Form and Instruction	New	Attachment F Interview Protocol
221003	HINTS 5 Cognitive Testing	Form and Instruction	New	Attachment E Questionnaire Content
221003	HINTS 5 Cognitive Testing	Form and Instruction	New	Attachment D Consent Form
221003	HINTS 5 Cognitive Testing	Form and Instruction	New	Attachment C Screening Questionnaire
220759	Formative Research to Investigate a Web Panel and to Determine Feasibility of Web-Based Cognitive Pretesting	Form and Instruction	New	Appendix B Screenshots Condition 2
220759	Formative Research to Investigate a Web Panel and to Determine Feasibility of Web-Based Cognitive Pretesting	Form and Instruction	New	Appendix A Screenshots Condition 1
215184	Generic Sub-study: Reliability Testing for Survey Questions about the Walking Environment	Form and Instruction	Unchanged	Appendix D Final Cognitive Probes
215184	Generic Sub-study: Reliability Testing for Survey Questions about the Walking Environment	Form and Instruction	Unchanged	Appendix C Final Random Order
215184	Generic Sub-study: Reliability Testing for Survey Questions about the Walking Environment	Form and Instruction	Unchanged	Appendix B Final Walking Behaviors First
215184	Generic Sub-study: Reliability Testing for Survey Questions about the Walking Environment	Form and Instruction	Unchanged	Appendix A Final Walking Environment First

ICR Details

OMB Control No: 0925-0589	ICR Reference No: 201511-0925-002
Status: Historical Active	Previous ICR Reference No: 201404-0925-003
Agency/Subagency: HHS/NIH	Agency Tracking No: 18889
Title: Questionnaire Cognitive Interviewing and Pretesting (NCI)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/16/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/12/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	07/31/2017	07/31/2017
Responses	18,000	0	2,800
Time Burden (Hours)	10,800	0	2,599
Cost Burden (Dollars)	0	0	0

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Abstract: A generic clearance is requested from OMB for general questionnaire development and pretesting activities to be carried out in 2014-2017 by the staff of the Applied Research Program, in the Division of Cancer Control and Population Sciences. Four types of activities will be carried out: survey questionnaire development and pretesting based on cognitive interviewing methodology, research on the cognitive aspects of survey methodology, research on computer-user interface design for computer-assisted instruments (including Web-based surveys), also known as Usability Testing, and Pilot Household interviews. For the revision we will add a fifth activity: 5) Formative research that depends on the use of interviewing techniques to develop products such as research priorities or expert consensus on best practices. Formative research has been increasingly used to develop new data collection instruments using psychometric procedures, including Computerized Adaptive Testing (CAT). Test-retest reliability testing can also be used as a type of formative research in the development of questionnaires, software applications that depend on self-report, and other measurement instruments.

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Authorizing Statute(s): US Code: 42 USC 412 Name of Law: Public Health Service Act
   US Code: 42 USC 410 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 402	01/03/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 22997	04/25/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Formative Research to Investigate a Web Panel and to Determine Feasibility of Web-Based Cognitive Pretesting	1, 2	Appendix A Screenshots Condition 1 ,   Appendix B Screenshots Condition 2
Generic Sub-study: Reliability Testing for Survey Questions about the Walking Environment	2, 3, 1, 4	Appendix A Final Walking Environment First ,   Appendix B Final Walking Behaviors First ,   Appendix C Final Random Order ,   Appendix D Final Cognitive Probes
HINTS 5 Cognitive Testing	2, 1, 3, 4	Attachment C Screening Questionnaire ,   Attachment D Consent Form ,   Attachment E Questionnaire Content ,   Attachment F Interview Protocol

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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	18,000	2,800	0	15,200	0	0
Annual Time Burden (Hours)	10,800	2,599	0	8,201	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: The total number of respondents previously approved didn’t account for the entire 3-year approval period. This change request was prompted by the desire of the NCI Division of Cancer Control and Population Sciences to perform a sub-study.

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Annual Cost to Federal Government: $247,088

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: 11/12/2015

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