The National Physician Survey of Precision Medicine in Cancer Treatment (NCI)

Forms and Documents

Document Name	Status
Form 4 Telephone Reminder Script Form and Instruction	New
Form 3 Non-response Follow-back Survey Form and Instruction	New
Form 2 Precision Medicine Survey Full Study Form and Instruction	New
Form 2 Precision Medicine Survey Pilot Study Form and Instruction	New
Form 1 Telephone Screener Form and Instruction	New
Precision 30-Day FRN.pdf Supplementary Document	2016-02-26
Attachment I Privacy Act Memo.pdf Supplementary Document	2016-02-22
Attachment H OHSRP Exemption.pdf Supplementary Document	2016-02-22
AttachG.References.docx Supplementary Document	2016-02-22
AttachF_Consultants.doc Supplementary Document	2016-02-22
AttachC_CoverLetters.docx Supplementary Document	2016-02-22
SSB Precision Medicine Final.docx Supporting Statement B	2016-05-12
SSA Precision Medicine Final.docx Supporting Statement A	2016-05-12

IC Document Collections

IC ID	Document Title	Status
220191	Telephone Reminder Script Form and Instruction	New
220189	Non-response Follow-back Survey Form and Instruction	New
220187	Precision Medicine Survey Full Study Form and Instruction	New
220184	Precision Medicine Survey Pilot Study Form and Instruction	New
220183	Telephone Screener Form and Instruction	New

ICR Details

OMB Control No: 0925-0739	ICR Reference No: 201602-0925-012
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: The National Physician Survey of Precision Medicine in Cancer Treatment (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 with change	Conclusion Date: 05/12/2016
	Date Received in OIRA: 03/01/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	24 Months From Approved
Responses	2,190	0	0
Time Burden (Hours)	350	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The purpose of this study is to investigate the current practice of precision medicine in cancer treatment among medical oncologists in the U.S. This is a nationally representative survey designed to assess oncologists’ current and potential use of genomic testing, to inform the development of interventions to facilitate optimal use of genomic testing and to improve patient-physician discussions of the risks, possible benefits, and uncertainties surrounding the use of these tests. Current knowledge of this topic is limited as there are no nationally-representative studies on this topic to date.

---

Authorizing Statute(s): US Code: 42 USC sect 285 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 72077	11/18/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 9869	02/26/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Non-response Follow-back Survey	3	Attachment E Nonresponse Followback Survey
Telephone Reminder Script	4	Attachment D Telephone Reminder
Telephone Screener	1	Attachment B Telephone Screener
Precision Medicine Survey Pilot Study	2	Attachment J NCI Precision Medicine Screenshots
Precision Medicine Survey Full Study	2	Attachment J NCI Precision Medicine Screenshots

---

ICR Summary 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	2,190	0	0	2,190	0	0
Annual Time Burden (Hours)	350	0	0	350	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 submission.

---

Annual Cost to Federal Government: $368,520

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

---

Common Form ICR:  No

---

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: 03/01/2016

---