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Federal forms, ICRs, and supporting documents

Information Collection Request

PHYSICIAN-BASED ASSESSMENT AND COUNSELING FOR EXERCISE (PACE): A PILOT STUDY

ICR 199204-0920-007 · OMB 0920-0303 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
111037 PHYSICIAN-BASED ASSESSMENT AND COUNSELING FOR EXERCISE (PACE): A PILOT STUDY Migrated
ICR Details
0920-0303 199204-0920-007
Historical Active
HHS/CDC
PHYSICIAN-BASED ASSESSMENT AND COUNSELING FOR EXERCISE (PACE): A PILOT STUDY
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/17/1992
Retrieve Notice of Action (NOA) 04/20/1992
This information collection is approved through 12/92 with the followi conditions: 1) CDC shall conduct a study subsequent to the proposed "pilot" study to test the new training materials and protocols (refined as a result of the data collected in the proposed study) against the original training and protocols. 2) Because the purpose of the proposed study is to "gather information about provider acceptability and usability of the PACE training materi and provider, office staff, and patient acceptability of the counselin protocols", CDC shall eliminate the following questions that do not re flect this purpose: **REMARKS CONTINUED**
  Inventory as of this Action Requested Previously Approved
12/31/1992 12/31/1992
960 0 0
552 0 0
0 0 0
THE DATA COLLECTIONS WILL INCLUDE THE PHYSICIAN'S PERSONAL PHYSICAL ACTIVITY HABITS, CURRENT HEALTH PROMOTION ACTIVITIES, AND ACTIVITY COUNSELING PRACTICES. RESPONDENTS INFORMATION WILL BE FROM OFFICE STA OF THE PHYSICIANS AND TELEPHONE SURVEYS OF RANDOMLY SELECTED PATIENTS THAT WERE SEEN BY THE PHYSICIAN DURING THE 6-MONTH PILOT. THE INFORMATION WILL BE USED TO EVALUATE THE PHYSICIAN ASSESSMENT AND
None
None
No
1
IC Title Form No. Form Name
PHYSICIAN-BASED ASSESSMENT AND COUNSELING FOR EXERCISE (PACE): A PILOT STUDY
  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 960 0 0 960 0 0
Annual Time Burden (Hours) 552 0 0 552 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/20/1992