[NCHHSTP] Formative Research and Tool Development

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0840 Primary Care Physician - HCV Email Reminder	Form and Instruction	New	Repair queued
Form 0920-0840 Primary Care Physician - HCV Discussion Guide	Form and Instruction	New	Repair queued
Form 0920-0840 Primary Care Physician - HCV Consent	Form and Instruction	New	Repair queued
Form 0920-0840 Primary Care Physician - HCV Screener	Form and Instruction	New	Repair queued
MARI Investigators Survey	Form and Instruction	Unchanged	Available
Justification Memo for Nonsubstantive Change Request_0920-0840_MARI Evaluation.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-10-03	Available
Attachment 2_MARI Investigators Survey_clean.docx	Supplementary Document	Uploaded 2024-10-03	Available
Att 12 Costs to respondents.xlsx	Supplementary Document	Uploaded 2024-01-23	Available
Att 10 List of Approved ICRs.docx	Supplementary Document	Uploaded 2024-01-23	Available
Att 9 Example Consent Form.docx	Supplementary Document	Uploaded 2024-01-26	Available
Att 9 Example Consent Form.docx	Supplementary Document	Uploaded 2024-01-26	Available
Att 7 Guide for Conducting Group Interview.docx	Supplementary Document	Uploaded 2024-01-26	Available
Att 6 Sample Screening Tool.docx	Supplementary Document	Uploaded 2024-01-26	Available
Att 5 Example Survey.docx	Supplementary Document	Uploaded 2024-01-26	Available
Att 4 Example Individual Interview Guide.docx	Supplementary Document	Uploaded 2024-01-26	Available
Att 3 Example Questions 8-2.docx	Supplementary Document	Uploaded 2024-01-26	Available
Att 2 60 Day FRN Pub 9-26-2-23.pdf	Supplementary Document	Uploaded 2024-01-23	Available
Att 1 AuthLegislation.docx	Supplementary Document	Uploaded 2024-01-23	Available
SSB.docx	Supporting Statement B	Uploaded 2021-05-14	Available
SSA.240123.docx	Supporting Statement A	Uploaded 2024-02-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
273522	[NCHHSTP] Interviews with Primary Care Providers on Hepatitis C	Form and Instruction	New	Primary Care Physician - HCV Email Reminder
273522	[NCHHSTP] Interviews with Primary Care Providers on Hepatitis C	Form and Instruction	New	Primary Care Physician - HCV Discussion Guide
273522	[NCHHSTP] Interviews with Primary Care Providers on Hepatitis C	Form and Instruction	New	Primary Care Physician - HCV Consent
273522	[NCHHSTP] Interviews with Primary Care Providers on Hepatitis C	Form and Instruction	New	Primary Care Physician - HCV Screener
268880	[NCHHSTP] Evaluation of the Minority HIV/AIDS Research Initiative (MARI): 2003-Present	Form and Instruction	Unchanged	MARI Investigators Survey
268880	[NCHHSTP] Evaluation of the Minority HIV/AIDS Research Initiative (MARI): 2003-Present	Other-Consent	Unchanged

ICR Details

OMB Control No: 0920-0840	ICR Reference No: 202410-0920-007
Status: Active	Previous ICR Reference No: 202401-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0840-24JF
Title: [NCHHSTP] Formative Research and Tool Development
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/04/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/04/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2027	03/31/2027	03/31/2027
Responses	121,800	0	121,800
Time Burden (Hours)	46,516	0	46,516
Cost Burden (Dollars)	0	0	0

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Abstract: The data collection and evidence are developed using a multitude of information sources and short term qualitative interviewing and cognitive research techniques have been proven invaluable in the development of scientifically valid and population-appropriate methods, interventions, and instruments. The activities conducted under this information collection will be used to inform many aspects of surveillance, communications, health promotion, and research project development for the 4 priority diseases (HIV, STDs, TB, and viral hepatitis) as well as school and adolescent health. This non-substantive change request is for minor modifications to the MARI investigators survey and does not impact burden.

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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:
	88 FR 66001	09/26/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 9149	02/09/2024
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
[NCHHSTP] Evaluation of the Minority HIV/AIDS Research Initiative (MARI): 2003-Present	n/a	MARI Investigators Survey
[NCHHSTP] Interviews with Primary Care Providers on Hepatitis C	0920-0840, 0920-0840, 0920-0840, 0920-0840	Primary Care Physician - HCV Screener ,   Primary Care Physician - HCV Consent ,   Primary Care Physician - HCV Discussion Guide ,   Primary Care Physician - HCV Email Reminder

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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	121,800	121,800	0	0	0	0
Annual Time Burden (Hours)	46,516	46,516	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $574,500

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? 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: 10/04/2024

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