Information Collection Request

Medical Monitoring Project

ICR 201002-0920-010 · OMB 0920-0740 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Patients Standard Interview Form Modified Available
0920_0740 Justification for Change.doc Justification for No Material/Nonsubstantive Change Uploaded 2010-02-24 Repair queued
0920_0740_Marked changes from 2009_2011 MMP Questionnaire.docx Supplementary Document Uploaded 2010-02-17 Available
Attachment12_ProviSurveyLtrs.doc Supplementary Document Uploaded 2009-03-12 Available
Attachment11_Model Scripts.doc Supplementary Document Uploaded 2009-03-12 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
188680 Physician/Nurse/Practitioner Provider Survey Instruction Removed
180569 Patients approached by facility staff for enrollment Instruction Modified
180568 Facility staff providing patient lists Instruction Modified
180566 Facility staff Providing Estimated Patient Loads Instruction Modified
180565 Facility Staff Medical Record Abstraction Instruction Modified
178498 Patient Short interview Instruction Modified
178497 Patients Standard Interview Form Modified
ICR Details
0920-0740 201002-0920-010
Historical Active 200904-0920-003
HHS/CDC
Medical Monitoring Project
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 03/01/2010
Retrieve Notice of Action (NOA) 02/26/2010
  Inventory as of this Action Requested Previously Approved
05/31/2012 05/31/2012 05/31/2012
20,045 0 22,334
8,500 0 9,603
0 0 0

The interview and medical record abstraction instruments have been updated since the last submission to OMB based on feedback from project areas participating in the 2007 data collection cycle. Data collection instruments were changed to ensure that interview questions will be easy for respondents to understand, and that data are collected on the medical record abstraction is consistent across all 26 project areas. Interview questions and medical record abstraction fields previously collected were deleted from the instruments. None of the changes to the data collection instruments altered the burdens estimated for the respondents. The Provider Survey is a new data collection and is incorporated as one of the paradigms in the Medical Monitoring Project.

US Code: 42 USC 301 (241.)a. Name of Law: Research and investigations generally
  
None

Not associated with rulemaking

  73 FR 32334 06/06/2008
74 FR 10916 03/13/2009
Yes

  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 20,045 22,334 0 -2,289 0 0
Annual Time Burden (Hours) 8,500 9,603 0 -1,103 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
Data collection forms were edited, primarily moving modules to improve flow. Three project areas were not funded this year, reducing the burden hours from 9,602 to 8,500.

$13,714,425
Yes Part B of Supporting Statement
Yes
Uncollected
Uncollected
No
Uncollected
Maryam Daneshvar 4046394604

  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.
02/26/2010