OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Formative Research to Support the Development of Sickle Cell Disease Educational Messages and Materials

ICR 201112-0920-001 · OMB 0920-0915 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Focus Group Moderator's Guide Form New Available
Participant Screener and Recruitment Form Form New Available
Demographic Information Sheet-1.docx Supplementary Document Uploaded 2012-01-05 Repair queued
SupportingStatementB_SCD (100511).docx Supporting Statement B Uploaded 2011-11-21 Available
Justification for Renumeration of Respondents 12012.docx Supplementary Document Uploaded 2012-01-05 Available
SUPPLEMENTAL3_ Informed Consent for Adults (100511) (2).docx Supplementary Document Uploaded 2011-11-21 Available
SUPPLEMENTAL2_Assent for Adolescents Aged 15-17 (100511) (2).docx Supplementary Document Uploaded 2011-11-21 Repair queued
SUPPLEMENTAL1_Permission Form for Parents of Adolescents Ages 15-17 (100511 (2).docx Supplementary Document Uploaded 2011-11-21 Available
Attachment 6_IRB Approval.pdf Supplementary Document Uploaded 2011-11-21 Available
Attachment 3_Privacy Protection Agreement (062011).pdf Supplementary Document Uploaded 2011-11-21 Available
Attachment2_60Day_SickleCell.pdf Supplementary Document Uploaded 2011-11-21 Available
Attachment 1_Public Health Service Act (42 USC 241).docx Supplementary Document Uploaded 2011-11-21 Repair queued
Demographic Information Sheet.docx Supplementary Document Uploaded 2011-11-21 Repair queued
Section_A Supporting Statement_SCD_(100511).docx Supporting Statement A Uploaded 2011-11-21 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
200325 Focus Group Moderator's Guide Form New
200324 Participant Screener and Recruitment Form Form New
ICR Details
0920-0915 201112-0920-001
Historical Active
HHS/CDC
Formative Research to Support the Development of Sickle Cell Disease Educational Messages and Materials
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 01/16/2012
Retrieve Notice of Action (NOA) 12/05/2011
  Inventory as of this Action Requested Previously Approved
01/31/2013 12 Months From Approved
210 0 0
204 0 0
0 0 0
The Centers for Disease Control and Prevention (CDC) seek to improve the quality of life of people living with sickle cell disease (SCD). To accomplish this goal, CDC aims to address the need for educational messages and materials for adolescents, young adults, adults, and older adults living with SCD. CDC is interested in understanding the informational needs of these audiences related to the adoption of health behaviors and the prevention of complications associated with SCD.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  76 FR 42711 07/19/2011
76 FR 74067 11/30/2011
No
2
IC Title Form No. Form Name
Participant Screener and Recruitment Form none Screener
Focus Group Moderator's Guide N/A Focus Group Guide
  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 210 0 0 210 0 0
Annual Time Burden (Hours) 204 0 0 204 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection request.
$176,918
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Daniel Holcomb 770 488-4472 [email protected]
  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.
12/05/2011