Information Collection Request

[NCCDPHP] Evaluation of a Prostate Cancer Decision Aid

ICR 202407-0920-009 · OMB 0920-1438 · Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-1438 can be found here:

2025-05-14 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Forms and supporting documents for this ICR
Document	Type	Status	Availability
Form 0920-24CB Pre-exposure Survey	Form	New	Available
Form 0920-24CB Pre-exposure Survey	Form	New	Repair queued
Form 0920-24CB Patient Eligibility Screener	Form	New	Available
Form 0920-24CB Patient Eligibility Screener	Form	New	Repair queued
Form 0920-24CB Provider Survey	Form	New	Available
Form 0920-24CB Provider Survey	Form	New	Missing upstream
Form 0920-24CB Clinic Coordinator Interview	Form	New	Available
Form 0920-24CB Clinic Coordinator Interview	Form	New	Repair queued
Form 0920-24CB Post-clinic Survey	Form	New	Available
Form 0920-24CB Post-clinic Survey	Form	New	Missing upstream
Form 0920-24CB User Experience Interview	Form	New	Available
Form 0920-24CB User Experience Interview	Form	New	Repair queued
Form 0920-24CB Usability Survey	Form	New	Available
Form 0920-24CB Usability Survey	Form	New	Repair queued
Form 0920-24CB Post-exposure survey	Form	New	Available
Form 0920-24CB Post-exposure survey	Form	New	Missing upstream
Attachment 13_Approved Privacy Narrative.pdf	Supplementary Document	Uploaded 2024-08-05	Available
Attachment 13_Approved Privacy Narrative.pdf	Supplementary Document	Uploaded 2024-08-05	Repair queued
4_Prostate Cancer_SSB.docx	Supporting Statement B	Uploaded 2024-08-05	Available
4_Prostate Cancer_SSB.docx	Supporting Statement B	Uploaded 2024-08-05	Repair queued
Attachment 14_Institutional Review Board Approval.docx	Supplementary Document	Uploaded 2024-08-02	Available
Attachment 14_Institutional Review Board Approval.docx	Supplementary Document	Uploaded 2024-08-02	Repair queued
Attachment 03_Evaluation Questions and Indicators.docx	Supplementary Document	Uploaded 2024-08-02	Available
Attachment 03_Evaluation Questions and Indicators.docx	Supplementary Document	Uploaded 2024-08-02	Repair queued
Attachment 02_Study Design Graphic.pdf	Supplementary Document	Uploaded 2024-08-02	Available
Attachment 02_Study Design Graphic.pdf	Supplementary Document	Uploaded 2024-08-02	Repair queued
Attachment 01_Authorizing Legislation.pdf	Supplementary Document	Uploaded 2024-08-02	Available
Attachment 01_Authorizing Legislation.pdf	Supplementary Document	Uploaded 2024-08-02	Repair queued
_List of Attachments_SSA & SSB.docx	Supplementary Document	Uploaded 2024-08-02	Available
_List of Attachments_SSA & SSB.docx	Supplementary Document	Uploaded 2024-08-02	Repair queued
3_Prostate Cancer_SSA.docx	Supporting Statement A	Uploaded 2024-08-02	Repair queued
3_Prostate Cancer_SSA.docx	Supporting Statement A	Uploaded 2024-08-02	Missing upstream

IC Document Collections

Information collection document groups
IC ID	Collection	Type	Status
269819	Pre-exposure Survey	Form	New
269819	Pre-exposure Survey	Form	New
269818	Patient Eligibility Screener	Form	New
269818	Patient Eligibility Screener	Form	New
269817	Provider Survey	Form	New
269817	Provider Survey	Form	New
269807	Clinic Coordinator Interview	Form	New
269807	Clinic Coordinator Interview	Form	New
269805	Post-clinic Survey	Form	New
269805	Post-clinic Survey	Form	New
269803	User Experience Interview	Form	New
269803	User Experience Interview	Form	New
269802	Usability Survey	Form	New
269802	Usability Survey	Form	New
269801	Post-exposure survey	Form	New
269801	Post-exposure survey	Form	New

ICR Details

Record metadata
Status	Active
Agency/Subagency	HHS/CDC
OMB Control No	0920-1438
Type of Information Collection	New collection (Request for a new OMB Control Number)
Agency Tracking No	0920-24CB
Date Submitted to OIRA	2024-08-06
Requested Expiration Date	1969-12-31