[NCCDPHP] Evaluation of a Prostate Cancer Decision Aid

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-24CB Pre-Exposure Survey_Online_Spanish	Form	Unchanged	Available
Form 0920-24CB Pre-Exposure Survey_Online_English	Form	Unchanged	Available
Form 0920-24CB Pre-exposure Survey	Form	Unchanged	Repair queued
Form 0920-24CB Patient Eligibility Screener_Spanish	Form	Unchanged	Available
Form 0920-24CB Patient Eligibility Screener_English	Form	Unchanged	Available
Form 0920-24CB Patient Eligibility Screener	Form	Unchanged	Repair queued
Form 0920-24CB Provider Survey	Form	Unchanged	Available
Form 0920-24CB Provider Survey	Form	Unchanged	Repair queued
Form 0920-24CB Clinic Coordinator Interviews_Interview Guide	Form	Unchanged	Available
Form 0920-24CB Clinic Coordinator Interview	Form	Unchanged	Repair queued
Form 0920-24CB Post-Clinic Visit Survey_Online_Spanish	Form	Unchanged	Available
Form 0920-24CB Post-Clinic Visit Survey_Online_English	Form	Unchanged	Available
Form 0920-24CB Post-clinic Survey	Form	Unchanged	Repair queued
Form 0920-24CB User Experience Interviews_Interview Guide_Spanish	Form	Unchanged	Available
Form 0920-24CB User Experience Interviews_Interview Guide_English	Form	Unchanged	Available
Form 0920-24CB User Experience Interview	Form	Unchanged	Missing upstream
Form 0920-24CB Usability Survey_Online_Spanish	Form	Unchanged	Available
Form 0920-24CB Usability Survey_Online_English	Form	Unchanged	Available
Form 0920-24CB Usability Survey	Form	Unchanged	Repair queued
Form 0920-24CB Post Exposure Survey _Spanish	Form	Unchanged	Available
Form 0920-24CB Post Exposure Survey _English	Form	Unchanged	Available
Form 0920-24CB Post-exposure survey	Form	Unchanged	Missing upstream
Change Request for CDC Prostate Cancer Screening Decision Aid Randomized Controlled Trial_2025April17.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-05-08	Available
Change Request for CDC Prostate Cancer Screening Decision Aid Randomized Controlled Trial_2025April17.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-05-08	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	Available
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	Available
3_Prostate Cancer_SSA.docx	Supporting Statement A	Uploaded 2024-08-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
269819	Pre-exposure Survey	Form	Unchanged	Pre-Exposure Survey_Online_Spanish
269819	Pre-exposure Survey	Form	Unchanged	Pre-Exposure Survey_Online_English
269819	Pre-exposure Survey	Form	Unchanged
269818	Patient Eligibility Screener	Form	Unchanged	Patient Eligibility Screener_Spanish
269818	Patient Eligibility Screener	Form	Unchanged	Patient Eligibility Screener_English
269818	Patient Eligibility Screener	Form	Unchanged
269817	Provider Survey	Form	Unchanged	Provider Survey
269817	Provider Survey	Form	Unchanged
269807	Clinic Coordinator Interview	Form	Unchanged	Clinic Coordinator Interviews_Interview Guide
269807	Clinic Coordinator Interview	Form	Unchanged
269805	Post-clinic Survey	Form	Unchanged	Post-Clinic Visit Survey_Online_Spanish
269805	Post-clinic Survey	Form	Unchanged	Post-Clinic Visit Survey_Online_English
269805	Post-clinic Survey	Form	Unchanged
269803	User Experience Interview	Form	Unchanged	User Experience Interviews_Interview Guide_Spanish
269803	User Experience Interview	Form	Unchanged	User Experience Interviews_Interview Guide_English
269803	User Experience Interview	Form	Unchanged
269802	Usability Survey	Form	Unchanged	Usability Survey_Online_Spanish
269802	Usability Survey	Form	Unchanged	Usability Survey_Online_English
269802	Usability Survey	Form	Unchanged
269801	Post-exposure survey	Form	Unchanged	Post Exposure Survey _Spanish
269801	Post-exposure survey	Form	Unchanged	Post Exposure Survey _English
269801	Post-exposure survey	Form	Unchanged

ICR Details

OMB Control No: 0920-1438	ICR Reference No: 202505-0920-004
Status: Active	Previous ICR Reference No: 202407-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-25-0104
Title: [NCCDPHP] Evaluation of a Prostate Cancer Decision Aid
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: 06/06/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/14/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2027	08/31/2027	08/31/2027
Responses	3,974	0	3,974
Time Burden (Hours)	1,129	0	1,129
Cost Burden (Dollars)	0	0	0

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Abstract: To conduct a randomized controlled trial (RCT) to determine if CDC’s online, simulated, human decision aid module, Talk to Nathan About Prostate Cancer Screening (treatment arm), is effective in improving knowledge, overcoming health literacy barriers, and resolving decisional conflict compared to a standard decision aid (control arm 1) and standard education materials (control arm 2). Also, to identify barriers and best practices for incorporating Talk to Nathan About Prostate Cancer Screening into the flow of primary care practice.

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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:
	89 FR 5237	01/26/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 58740	07/19/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Clinic Coordinator Interview	0920-24CB	Clinic Coordinator Interviews_Interview Guide
Patient Eligibility Screener	0920-24CB, 0920-24CB	Patient Eligibility Screener_English ,   Patient Eligibility Screener_Spanish
Post-clinic Survey	0920-24CB, 0920-24CB	Post-Clinic Visit Survey_Online_English ,   Post-Clinic Visit Survey_Online_Spanish
Post-exposure survey	0920-24CB, 0920-24CB	Post Exposure Survey _English ,   Post Exposure Survey _Spanish
Pre-exposure Survey	0920-24CB, 0920-24CB	Pre-Exposure Survey_Online_English ,   Pre-Exposure Survey_Online_Spanish
Provider Survey	0920-24CB	Provider Survey
Usability Survey	0920-24CB, 0920-24CB	Usability Survey_Online_English ,   Usability Survey_Online_Spanish
User Experience Interview	0920-24CB, 0920-24CB	User Experience Interviews_Interview Guide_English ,   User Experience Interviews_Interview Guide_Spanish

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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	3,974	3,974	0	0	0	0
Annual Time Burden (Hours)	1,129	1,129	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: This is a new collection requesting three years of approval for 1,129 hours per year.

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Annual Cost to Federal Government: $16,000

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)? 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: 05/14/2025

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