Assessment of the Cancer Survivorship Demonstration Project

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Web-based Partner Survey	Form	New	Available
Web-based Grantee Survey	Form	New	Available
Att 6_RTI IRB Decision Memo.pdf	Supplementary Document	Uploaded 2018-11-01	Available
Att 5_Intro Data Collection Email to DP15-1501 Grantees.docx	Supplementary Document	Uploaded 2018-11-01	Available
Att 3i_Web-based Survey Items By Respondent Type.docx	Supplementary Document	Uploaded 2018-11-01	Available
Att 2_60 Day FRN Published.pdf	Supplementary Document	Uploaded 2018-11-01	Available
Att 1_Section 301 of the Public Health Service Act.pdf	Supplementary Document	Uploaded 2018-11-01	Available
Supporting Statement B_CDC Survivorship.docx	Supporting Statement B	Uploaded 2018-11-01	Available
Supporting Statement A_CDC Survivorship - QNH edits CLEAN.docx	Supporting Statement A	Uploaded 2019-01-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
233844	Telephone Interview	Other-Interview Guide	New
233843	Web-based Partner Survey	Form	New
233842	Web-based Grantee Survey	Form	New

ICR Details

OMB Control No: 0920-1250	ICR Reference No: 201811-0920-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-18AG
Title: Assessment of the Cancer Survivorship Demonstration Project
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: 02/04/2019
	Date Received in OIRA: 11/20/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	36 Months From Approved
Responses	56	0	0
Time Burden (Hours)	28	0	0
Cost Burden (Dollars)	721	0	0

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Abstract: This Information collection aims to assess six Division of Cancer Prevention and Control National Comprehensive Cancer Control Program DP15-1501-funded grantees' efforts. The assessment will determine their ability to implement evidence-based and promising strategies to increase knowledge of cancer survivor needs, increase utilization of surveillance data to inform program planning by providers and coalition members, and enhance partnerships to facilitate and broaden program reach. Information will be collected from DP15-1501 grantee staff and partners in two waves via Web-based surveys and semistructured telephone interviews.

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Authorizing Statute(s): US Code: 42 USC 241 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:
	82 FR 52301	11/13/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 58570	11/20/2018
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
Web-based Grantee Survey	none, none	Grantee Survey ,   Grantee Survey - screenshots
Web-based Partner Survey	none, none	Partner Survey ,   Partner Survey - screenshots
Telephone Interview

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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	56	0	0	56	0	0
Annual Time Burden (Hours)	28	0	0	28	0	0
Annual Cost Burden (Dollars)	721	0	0	721	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 ICR.

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Annual Cost to Federal Government: $54,360

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 11/20/2018

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