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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2 Pilot Study	Form	New	Available
Form 1 Individual Main Study	Form	New	Available
Form 1 Health Information National Trends Survey	Form and Instruction	Removed	Available
30-Day FRN HINTS.pdf	Supplementary Document	Uploaded 2016-08-25	Available
Appendix G2 - Privacy Act Memo.pdf	Supplementary Document	Uploaded 2016-08-19	Available
Appendix M - References.pdf	Supplementary Document	Uploaded 2016-08-19	Available
Appendix L - Instrument Changes.pdf	Supplementary Document	Uploaded 2016-08-19	Available
Appendix K- Theoretical Framework.pdf	Supplementary Document	Uploaded 2016-08-19	Available
Appendix J2 - Westat IRB Approval.pdf	Supplementary Document	Uploaded 2016-08-19	Available
Appendix J1 - NCI OHSRP Determination.pdf	Supplementary Document	Uploaded 2016-08-19	Available
Appendix I - Westat Confidentiality Pledge.pdf	Supplementary Document	Uploaded 2016-08-19	Available
Appendix H - OMB approved incentives.pdf	Supplementary Document	Uploaded 2016-08-19	Available
Appendix G1 - PIA.pdf	Supplementary Document	Uploaded 2016-08-19	Available
Appendix F - Health People 2020 Objectives.pdf	Supplementary Document	Uploaded 2016-08-19	Available
Appendix C - HINTS IV Publications Overview .pdf	Supplementary Document	Uploaded 2016-08-19	Available
Appendix B - Cover Letters & FAQs.pdf	Supplementary Document	Uploaded 2016-08-19	Available
Appendix A - History of HINTS.pdf	Supplementary Document	Uploaded 2016-08-19	Available
SSA HINTS Final 8.17.2016.docx	Supporting Statement A	Uploaded 2016-08-19	Available
SSB HINTS Final.docx	Supporting Statement B	Uploaded 2016-08-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
223114	Pilot Study	Form	New
223113	Individual Main Study	Form	New
215033	Health Information National Trends Survey	Form and Instruction	Removed

ICR Details

OMB Control No: 0925-0538	ICR Reference No: 201608-0925-002
Status: Historical Inactive	Previous ICR Reference No: 201502-0925-003
Agency/Subagency: HHS/NIH	Agency Tracking No: 19700
Title: Health Information National Trends Survey V (HINTS V) (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OIRA Conclusion Action: Withdrawn	Conclusion Date: 02/02/2017
	Date Received in OIRA: 08/25/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved	04/30/2016
Responses	0	0	4,318
Time Burden (Hours)	0	0	2,159
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a request to OMB for a reinstatement with change, three additional years of data collection for the Health Information National Trends Survey (HINTS). As in the past, HINTS V will provide NCI with 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. The content of the survey will focus on understanding the degree to which members of the general population understand vital cancer prevention messages. More importantly, this NCI survey will couple knowledge-related questions with inquiries into the communication channels through which understanding is being obtained, and assessment of cancer-related behavior. Working with the Office of the National Coordinator, HINTS V will include an additional focus on the public’s use of electronic medical and health records.

---

Authorizing Statute(s): US Code: 42 USC 285(a) Name of Law: Public Health Service Act
   US Code: 42 USC 412(285a-1) 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:
	81 FR 36316	06/06/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 58525	08/25/2016
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Pilot Study	2	Pilot Instrument
Health Information National Trends Survey	1	B1- Instrument in English
Individual Main Study	1	Main Study - Cycle 1 Instrument

---

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: This submission requests a reinstatement with changes that will reinstatement the burden of this information collection and provide data for comparison with the previous HINTS survey data. HINTS V will use the same sampling and data collection strategy as HINTS IV. The data collection instruments for HINTS V will vary slightly from those in HINTS IV to reflect evolving government priorities (as described in detail in section A.1, page 3), although there will always be a core of at least 50% of the instrument which will remain the same as HINTS IV. The changes made to the instrument from the HINTS IV cycle can be found in Appendix L. For this first cycle of HINTS V, the survey instrument (found in Appendix D) has a total of 139 survey items. Of these, 26.5 items (19%) are new to HINTS. As noted in section A.2, most of these new items were developed in conjunction with the ONC and focus on the public’s interactions with a connected healthcare system. Section A.16 below describes the analytic importance of these new items in combination with traditional HINTS items. The remaining 112.5 items on the HINTS V, Cycle 1 instrument were either fielded on HINTS IV, Cycle 4 (75%) or on earlier HINTS cycles (6%). Appendix L lists all changes from HINTS 4, Cycle 4. In addition, HINTS V will include a pilot study, which increases the annual burden request from 1,750 in HINTS IV to 2,017 in HINTS V. This is an overall increase of 217

---

Annual Cost to Federal Government: $799,066

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: 08/25/2016

---