GENIC Template

Request for genIC Approval

CDC/ATSDR Formative Research and Tool Development

0920-1154 (Expiration Date: 1/31/2020)

CIO: National Center for Chronic Disease Prevention and Health Promotion

PROJECT TITLE: CDC’s Inside Knowledge Campaign: 2018 Focus Group Research and Testing with the General Public and Hispanic Audiences

PURPOSE AND USE OF COLLECTION:

To examine knowledge, attitudes, and behaviors related to the five main gynecologic cancers—cervical, ovarian, uterine, vaginal, and vulvar; and to assess Inside Knowledge: Get the Facts About Gynecologic Cancer campaign messages and creative concepts for use in public service advertisements that raise awareness among women about the signs, symptoms, risk factors, and prevention strategies related to gynecologic cancers.

This focus group research and testing is part of a larger project. In January 2007, the Gynecologic Cancer Education and Awareness Act of 2005 was signed into law, authorizing CDC, in collaboration with the U.S. Department of Health and Human Services’ Office on Women’s Health, to develop the Inside Knowledge: Get the Facts About Gynecologic Cancer campaign (www.cdc.gov/cancer/knowledge). This national multimedia initiative raises awareness among women and health care providers about the signs, symptoms, risk factors, and prevention strategies related to the five main gynecologic cancers—cervical, ovarian, uterine, vaginal, and vulvar.

DESCRIPTION OF RESPONDENTS:

1. General Public and (2) Women aged 35-65 years

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. Information gathered will not be used to substantially inform influential policy decisions.

5. The study is not intended to produce results that can be generalized beyond its scope.

Name: Cynthia A. Gelb

To assist review, please answer the following questions:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ X ] Yes [ ] No

BURDEN HOURS

Category of Respondent	Form Name	No. of Respondents	Participation Time (minutes)	Burden in Hours
Individuals (General Public)	Screening and Recruitment Form	576	15/60	144
Individuals (Women aged 35-65 years)	Focus Group Discussion Guide	288	2	576
Totals				720

FEDERAL COST: The estimated annual cost to the Federal government is $259,700.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [X] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

Respondents will be recruited using public information (e.g. telephone directory), public venues (e.g. city parks), as well as proprietary lists (e.g. lists maintained by focus group facilities and professional focus group recruitment consultants).

The recruitment and screening process is designed to identify respondents who are in the target age range; speak English or Spanish; have not had a hysterectomy; and (with the exception of skin cancer) have not been previously diagnosed with any kind of cancer, and have not had more than one close female friend or family member who was diagnosed with any cancer. Additional demographic questions are designed to ensure that focus groups include a mix of respondents.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[X] Telephone

[X] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X] Yes [ ] No

Please make sure all instruments, instructions, and scripts are submitted with the request.

Instructions for completing genIC Request for Approval for

CDC/ATSDR Formative Research and Tool Development

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is requested.

PURPOSE and USE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Briefly describe the targeted group/groups for this collection.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households; (2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected.

Form: Provide the title of the information collection form.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group).

Burden in Minutes: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Estimate the annual cost to the Federal government for this collection.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

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