Information Collection Request

Assessing Problem Areas in Referrals for Chronic Hematologic Malignancies and Developing Interventions to Address Them

ICR 200910-0920-010 · OMB 0920-0836 · Historical Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-0836 can be found here:

2010-04-05 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document	Type	Status	Availability
Att 6A_08AU_ Informed Consent Patients.pdf	Supplementary Document	Uploaded 2009-12-29	Repair queued
Att 4A_08AU_ Informed Consent Physicians.pdf	Supplementary Document	Uploaded 2009-12-29	Available
Att 14A_08AU_Informed Consent Physician Focus Group.doc	Supplementary Document	Uploaded 2009-12-29	Repair queued
08AU_Supporting Statement B_092309.doc	Supporting Statement B	Uploaded 2009-10-01	Available
Att 17_Overall Study Plan with Publications 092309.xls	Supplementary Document	Uploaded 2009-10-01	Repair queued
Att 16_description of CDC funded Hematology Projects 092309.pdf	Supplementary Document	Uploaded 2009-10-01	Available
Att 15_IRB Approval Letters 092309.doc	Supplementary Document	Uploaded 2009-10-01	Available
Att 2b_Summary of Public Comments 092309.doc	Supplementary Document	Uploaded 2009-10-01	Repair queued
Att 2_Published 60d FRN_092309.pdf	Supplementary Document	Uploaded 2009-10-01	Available
Att 1_Section 301 of the Public Health Service Act.doc	Supplementary Document	Uploaded 2009-10-07	Available
08AU_SS_A_Revised 12.09.09.doc	Supporting Statement A	Uploaded 2009-12-29	Available

IC Document Collections

IC ID	Collection	Type	Status
191097	Primary care Providers Focus Group Guide	Other-WORD	New
191096	Primary Care Provider Focus Group Phone Recruitment Script	Other-WORD	New
191095	Primary Care Provider Interview Guide	Other-WORD	New
191094	Primary Care Provider Interview Phone Recruitment Script	Other-WORD	New
191093	Primary Care Provider Reminder Letter	Other-WORD	New
191092	Primary Care Provider Opt-Out Card	Other-WORD	New
191091	Primary Care Provider Survey	Other-WORD	New
191090	Primary Care Provider Survey Cover Letter	Other-WORD	New
191089	Patient Interview Guide	Other-WORD	New
191088	Patient Interveiw Phone Recruitment Script	Other-WORD	New
191087	Community Oncologists and Hematologists Interviews Guide	Other-W(RD	New
191086	Community Oncologists and Hematologists Interview Phone Recruitment Script	Other-WORD	New

ICR Details

OMB Control No: 0920-0836	ICR Reference No: 200910-0920-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Assessing Problem Areas in Referrals for Chronic Hematologic Malignancies and Developing Interventions to Address Them
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/31/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/23/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2010	12 Months From Approved
Responses	1,072	0	0
Time Burden (Hours)	198	0	0
Cost Burden (Dollars)	13,837	0	0

Abstract: CDC proposes to collect information from Primary Care Providers, community oncologists, community hematologists, and patients about referral practices for patients with chronic hematological malignancies. Information will be used to develop a prototype intervention designed to facilitate timely care for patients with chronic hematologic disease.

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 16873	04/13/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 50800	10/01/2009
Did the Agency receive public comments on this ICR? Yes

Number of Information Collection (IC) in this ICR: 12

IC Title	Form No.	Form Name
Community Oncologists and Hematologists Interview Phone Recruitment Script
Community Oncologists and Hematologists Interviews Guide
Patient Interveiw Phone Recruitment Script
Patient Interview Guide
Primary Care Provider Survey Cover Letter
Primary Care Provider Survey
Primary Care Provider Opt-Out Card
Primary Care Provider Reminder Letter
Primary Care Provider Interview Guide
Primary Care Provider Interview Phone Recruitment Script
Primary Care Provider Focus Group Phone Recruitment Script
Primary care Providers Focus Group Guide

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	1,072	1,072
Annual Time Burden (Hours)	198	198
Annual Cost Burden (Dollars)	13,837	13,837

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: CDC proposed to conduct a new, one-time information collection involving primary care providers, community oncologists and hematologists, and patients with chronic hematologic malignancies. Information will be used to develop a prototype intervention to facilitate appropriate medical care for patients and timely referral from primary care providers to cancer specialists. The information needed to develop appropriate, targeted intervention is not available from other sources.

Annual Cost to Federal Government: $452,500

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Thelma Sims 4046394771

Common Form ICR: No