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 201305-0920-007 · OMB 0920-0915 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
SupSta_B_0915.docx Supporting Statement B Uploaded 2013-05-10 Available
Att 3_Priv Prot Agreement.pdf Supplementary Document Uploaded 2013-05-10 Available
Att 6_IRB Approval.pdf Supplementary Document Uploaded 2013-05-10 Available
Att 2_60dy_SCD_0915.pdf Supplementary Document Uploaded 2013-05-10 Available
Att 1_PHSA (42 USC 241).docx Supplementary Document Uploaded 2013-05-10 Available
Demographic Information Sheet-1.docx Supplementary Document Uploaded 2012-01-05 Available
SUPPLEMENTAL3_ Informed Consent for Adults (100511) (2).docx Supplementary Document Uploaded 2013-05-10 Available
SUPPLEMENTAL2_Assent for Adolescents Aged 15-17 (100511) (2).docx Supplementary Document Uploaded 2013-05-10 Available
SUPPLEMENTAL1_Permission Form for Parents of Adolescents Ages 15-17 (100511 (2).docx Supplementary Document Uploaded 2013-05-10 Available
SupSta_A_0915.docx Supporting Statement A Uploaded 2013-05-10 Available
IC Document Collections
IC IDCollectionTypeStatusForm
200325 Focus Group Moderator's Guide Other-WORD Modified
200324 Participant Screener and Recruitment Form Other-WORD Modified
ICR Details
0920-0915 201305-0920-007
Historical Active 201112-0920-001
HHS/CDC 19578
Formative Research to Support the Development of Sickle Cell Disease Educational Messages and Materials
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 06/12/2013
Retrieve Notice of Action (NOA) 05/14/2013
  Inventory as of this Action Requested Previously Approved
06/30/2014 12 Months From Approved
210 0 0
204 0 0
0 0 0
CDC seeks 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 healthy behaviors and the prevention of complications associated with SCD. To develop these messages and materials, CDC will conduct formative focus groups with people with SCD across the country.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  78 FR 3429 01/16/2013
78 FR 27391 05/10/2013
No
2
IC Title Form No. Form Name
Participant Screener and Recruitment Form
Focus Group Moderator's 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 Reinstatement without change of a previously approved collection.
$176,918
Yes Part B of Supporting Statement
Yes
No
No
No
Uncollected
Thelma Sims 4046394771
  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.
05/14/2013