OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Risk Perception, Worry, and Use of Ovarian Cancer Screening among Women at High, Elevated, and Average Risk of Ovarian Cancer

ICR 200704-0920-001 · OMB 0920-0744 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Follow-up Questionnaire Form and Instruction New Available
Telephone Screener (pages E1-E4 of the Baseline Questionnaire Form) Form and Instruction New Repair queued
Baseline Questionnaire (pages E5-E27 of the Baseline Questionnaire Form) Form and Instruction New Available
OMB Response 7_12_07.doc Supplementary Document Uploaded 2007-07-24 Available
Supporting Statement part B 4-3-2007.doc Supporting Statement B Uploaded 0000-00-00 Available
ATTACHMENT B.60day notice.doc Supplementary Document Uploaded 0000-00-00 Available
ATTACHMENT D. Henry Ford IRB approval.doc Supplementary Document Uploaded 0000-00-00 Available
ATTACHMENT C.IRB approval.doc Supplementary Document Uploaded 0000-00-00 Available
Supporting Statement part A 4-3-2007.doc Supporting Statement A Uploaded 0000-00-00 Available
IC Document Collections
IC IDCollectionTypeStatusForm
179711 Follow-up Questionnaire Form and Instruction New
179710 Telephone Screener (pages E1-E4 of the Baseline Questionnaire Form) Form and Instruction New
179709 Baseline Questionnaire (pages E5-E27 of the Baseline Questionnaire Form) Form and Instruction New
ICR Details
0920-0744 200704-0920-001
Historical Active
HHS/CDC
Risk Perception, Worry, and Use of Ovarian Cancer Screening among Women at High, Elevated, and Average Risk of Ovarian Cancer
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 07/25/2007
Retrieve Notice of Action (NOA) 04/19/2007
Approved consistent with CDC response to OMB questions and comments.
  Inventory as of this Action Requested Previously Approved
07/31/2010 36 Months From Approved
11,867 0 0
1,411 0 0
0 0 0
A baseline survey will be administered through a computer-assisted telephone interview (CATI) program to 2,000 women affiliated with Henry Ford Health Systems in Detroit, MI. Women will be asked a series of questions over a 35-minute (.58 hour) time period. Questions will cover key variables related to ovarian cancer screening including coping, anxiety, perceived risk, worry, family cancer history, closeness to family member of friend who has had cancer, and screening behavior. A shortened follow-up survey will be administered to approximately 1,600 of the women included at baseline (15% attrition).
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  71 FR 15187 03/27/2006
72 FR 17553 04/09/2007
No
  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 11,867 0 0 11,867 0 0
Annual Time Burden (Hours) 1,411 0 0 1,411 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection activity designed to examine the perception of risk for ovarian cancer and its relationship to screening behavior.
$315,155
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected
Saleda Perryman
  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.
04/19/2007