Information Collection Request

CDC Cervical Cancer Study (CX3)

ICR 201205-0920-008 · OMB 0920-0814 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Focus Groups with Health Care Providers Form Modified Repair queued
Follow-up Provider Survey Form Modified Repair queued
Follow-up Patient Survey Form Modified Available
0920-0814_Part B_04 27 2012.docx Supporting Statement B Uploaded 2012-05-16 Available
F2 Analysis tables revised.pdf Supplementary Document Uploaded 2012-05-16 Available
G3 Certificate of Confidentiality.pdf Supplementary Document Uploaded 2012-05-16 Repair queued
G2 Battelle IRB Approval.pdf Supplementary Document Uploaded 2012-05-16 Available
G1 CDC IRB approval.docx Supplementary Document Uploaded 2012-05-16 Repair queued
F1 Variables collected revised.docx Supplementary Document Uploaded 2012-05-16 Available
E Medical Records Review.doc Supplementary Document Uploaded 2012-05-16 Available
B2 Summary of Public Comments and CDC Response.pdf Supplementary Document Uploaded 2012-05-16 Available
Attachment B1 Federal Register Notice.pdf Supplementary Document Uploaded 2012-05-16 Available
A Authorizing Legislation.doc Supplementary Document Uploaded 2012-05-16 Available
Att E2d_Script for reminder phone call_0209.doc Supplementary Document Uploaded 2009-02-23 Available
Att E2a_Initial postcard_0209.doc Supplementary Document Uploaded 2009-02-23 Available
Att E2c_Reminder postcard_0209.doc Supplementary Document Uploaded 2009-02-23 Available
Att E2b_Cover letter patient follow-up survey_0209.doc Supplementary Document Uploaded 2009-02-23 Repair queued
Att E1c_HPV patient consent form not including patient survey_0209.doc Supplementary Document Uploaded 2009-02-23 Repair queued
Att Elb_HPV patient consent form including patient survey_0209.doc Supplementary Document Uploaded 2009-02-23 Available
Att D2a_ Cover letter -- follow-up provider surveys_0209.doc Supplementary Document Uploaded 2009-02-23 Repair queued
C2a Consent Form for Provider Focus Group Interviews.docx Supplementary Document Uploaded 2012-05-17 Repair queued
C1a Cover Letter for Follow-up Provider Survey.docx Supplementary Document Uploaded 2012-05-17 Repair queued
D1e SCRIPT FOR REMINDER TELEPHONE CALL.doc Supplementary Document Uploaded 2012-05-17 Repair queued
D1d Reminder postcard.doc Supplementary Document Uploaded 2012-05-17 Available
D1b Initial Postcard.doc Supplementary Document Uploaded 2012-05-17 Available
D1c Cover Letter for Patient Follow-up Survey.docx Supplementary Document Uploaded 2012-05-17 Repair queued
D1a Patient Consent Survey.pdf Supplementary Document Uploaded 2012-05-17 Available
0920-0814_Part A_04 27 2012.docx Supporting Statement A Uploaded 2012-05-16 Available
IC Document Collections
IC IDCollectionTypeStatusForm
188627 Cx3 Study - Follow-up Patient Survey Other-WORD Removed
188626 Cx3 Study - Patient Enrollment Form Other-WORD Removed
188625 Cx3 Study - Patient Recruitment Other-WORD Removed
188624 Cx3 Study - Baseline Patient Survey Other-WORD Removed
188623 Cx3 Study - Follow-up Provider Survey Other-WORD Removed
188622 Focus Groups with Health Care Providers Form Modified
188621 Follow-up Provider Survey Form Modified
188620 Follow-up Patient Survey Form Modified
ICR Details
0920-0814 201205-0920-008
Historical Active 200903-0920-010
HHS/CDC
CDC Cervical Cancer Study (CX3)
Revision of a currently approved collection   No
Regular
Approved without change 07/02/2012
Retrieve Notice of Action (NOA) 05/22/2012
  Inventory as of this Action Requested Previously Approved
07/31/2013 12 Months From Approved 06/30/2012
295 0 7,632
135 0 1,006
0 0 0

The purpose of this study is to examine whether or not there is an increase in the cervical cancer screening interval to 3 years for women in the target age range with a normal Pap test and a negative HPV DNA test.

US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  77 FR 9960 02/17/2012
77 FR 28881 05/16/2012
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 295 7,632 0 -7,337 0 0
Annual Time Burden (Hours) 135 1,006 0 -871 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
This is a revision with reduction in burden hours. Due to a decrease in the number of instruments to be fielded in this phase of data collection (the period of this Revision ICR), there will be an overall reduction in burden hours. The following instruments will be discontinued: the Initial Clinic Survey, the Follow-Up Clinic Survey, the Baseline Provider Survey, the Patient Screening Script, the Patient Enrollment Form, and the Baseline Patient Survey. Information collection for these study components was completed.

$817,586
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Tony Richardson 404 639-4965 [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.
05/22/2012