Understanding the Needs of Ovarian Cancer Survivors

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920- Mail-in Questionnaire	Form and Instruction	New	Available
Form 0920- Web-based Screener (Ovarian Cancer Survivorship Survey)	Form	New	Available
Form 0920- Ovarian Cancer Survivorship Survey Screener	Form and Instruction	New	Available
Form 0920- Ovarian Cancer Survivorship Survey	Form and Instruction	New	Available
OCS Att 5b web-based FAQ Final.pdf	Supplementary Document	Uploaded 2020-06-15	Repair queued
OCS Att 4c Mailed Initial Questionnaire State Cancer Registry Recruitment Reminder Final.docx	Supplementary Document	Uploaded 2020-06-15	Available
OCS Att 4d Mailed Final Questionnaire State Cancer Registry Recruitment Reminder Final.docx	Supplementary Document	Uploaded 2020-06-15	Available
OCS Att 4b mailed FAQs Final.docx	Supplementary Document	Uploaded 2020-06-15	Available
OCS Att 4a Mailed Invite Ltr State Cancer Registry Recruitment Final.docx	Supplementary Document	Uploaded 2020-06-15	Available
OCS Att 7a NORC approval Final.doc.pdf	Supplementary Document	Uploaded 2020-06-15	Available
OCS Att 2 60 day published Final.pdf	Supplementary Document	Uploaded 2020-06-15	Available
OCS Att 1 Sec 301 PHSA Final.pdf	Supplementary Document	Uploaded 2020-06-15	Available
OCS_SSB_Final_EOP (09-28-20)_comments_clean 03DEC2020.docx	Supporting Statement B	Uploaded 2020-12-03	Available
OCS SSA_Final_EOP (09-28-20)_comments_clean 03DEC2020.docx	Supporting Statement A	Uploaded 2020-12-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
242266	Att 3a_Mail-In or Web-based Questionnaire	Form and Instruction	New	Mail-in Questionnaire
242265	Att 3c_Web-based Screener (ONLY)	Form	New	Web-based Screener (Ovarian Cancer Survivorship Survey)
242254	Att 3b_ Web-Based Screener & Informed Consent	Form and Instruction	New	Ovarian Cancer Survivorship Survey Screener
242243	Att 3b_Web-based Questionnaire	Form and Instruction	New	Ovarian Cancer Survivorship Survey

ICR Details

OMB Control No: 0920-1314	ICR Reference No: 202006-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-19BHM
Title: Understanding the Needs of Ovarian Cancer Survivors
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: 12/04/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/16/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	12 Months From Approved
Responses	1,600	0	0
Time Burden (Hours)	1,254	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Ovarian cancer survivors, a group whose needs are unique compared with other cancer survivor groups due to a variety of factors including a lack of screening options, typical late stage diagnosis, and lower survival rates. The purpose of this study is to gather information on the needs of ovarian cancer survivors in order to help public health programs develop and implement interventions aimed at improving survivor health.

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Authorizing Statute(s): PL: Pub.L. 301 - 241 Public Health Service Act Name of Law: PART A. RESEARCH AND INVESTIGATIONS
  

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:
	84 FR 32187	07/05/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 5667	01/31/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Att 3a_Mail-In or Web-based Questionnaire	0920-	Mail-in Questionnaire
Att 3b_ Web-Based Screener & Informed Consent	0920-	Ovarian Cancer Survivorship Survey Screener
Att 3b_Web-based Questionnaire	0920-	Ovarian Cancer Survivorship Survey
Att 3c_Web-based Screener (ONLY)	0920-	Web-based Screener (Ovarian Cancer Survivorship Survey)

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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	1,600	0	0	1,600	0	0
Annual Time Burden (Hours)	1,254	0	0	1,254	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 information collection request

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Annual Cost to Federal Government: $308,752

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.     Yes

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.     Yes

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)? Yes

Is this ICR related to the Pandemic Response? No

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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: 06/16/2020

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