OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Experiences with the Implementation and Outcomes of Policy and Environmental Cancer Control Interventions

ICR 201510-0920-001 · OMB 0920-1016 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920- CCC Partners TA Provider Focus Group Guide Form and Instruction Unchanged Available
Form 0920- CCC Partners Key Informant Interview Guide Form and Instruction Unchanged Available
Form 0920- CCC Partners Key Informant Recruitment/Scheduling Form and Instruction Unchanged Available
Form 0920- CCC Staff Key Informant Recruitment/Scheduling Form and Instruction Unchanged Available
Form 0920- CCC Staff Key Informant Selection Form and Instruction Unchanged Available
Form 0920- CCC Program Director Web Survey Questionnaire Form and Instruction Unchanged Available
0920-1016 Change Request Justification_10 08 15.docx Justification for No Material/Nonsubstantive Change Uploaded 2015-10-09 Available
13PR Part_B_01 16 2014.docx Supporting Statement B Uploaded 2014-02-10 Available
Att D5_ Informed_Consent_for_Key_Informant_Interview_1_23_14 (3).docx Supplementary Document Uploaded 2014-02-11 Available
Att D2_ Initial_Site_Contact_Email_10_29_13.docx Supplementary Document Uploaded 2014-02-11 Available
Att G_Battelle IRB Approval Letter_10_29_13.pdf Supplementary Document Uploaded 2014-02-11 Available
Att A _Authorizing_Legislation.docx Supplementary Document Uploaded 2014-02-11 Available
Att B2_Summary of Public Comments.doc Supplementary Document Uploaded 2014-02-10 Available
Att E2_TA Provider Focus_Group_Invitation_11_01_13.docx Supplementary Document Uploaded 2014-02-11 Available
Att F5_Coalition_Survey_Thank You E-Mail.docx Supplementary Document Uploaded 2014-02-11 Available
Att F4_Coalition_Survey_Reminder E-Mail.docx Supplementary Document Uploaded 2014-02-11 Available
Att F3_Coalition_Survey_Recruitment E-Mail.docx Supplementary Document Uploaded 2014-02-11 Available
Att F2_Coalition_Survey_Advance E-Mail.docx Supplementary Document Uploaded 2014-02-11 Available
Att D1_Key_Informant_Interview_11_01_13.docx Supplementary Document Uploaded 2014-02-11 Available
Att D1_Key_Informant_Interview_11_01_13.docx Supplementary Document Uploaded 2014-02-11 Available
Att D1_Key_Informant_Interview_11_01_13.docx Supplementary Document Uploaded 2014-02-11 Available
Att C5_ Program_Director_Thankyou_E-Mail_10_29_13.docx Supplementary Document Uploaded 2014-02-11 Available
Att C2 _Program_Director_Advance_Letter_10_29_13.docx Supplementary Document Uploaded 2014-02-11 Available
Att C3_Program_Director_Advance_E-Mail_10_29_13.docx Supplementary Document Uploaded 2014-02-11 Available
Att C4_ Program_Director_Reminder_E-Mail_10_29_13.docx Supplementary Document Uploaded 2014-02-11 Repair queued
13PR Part_A_01 16 2014.docx Supporting Statement A Uploaded 2014-02-10 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
210390 CCC Partners TA Provider Focus Group Guide Form and Instruction Unchanged
210389 PSE Change Network Survey Other-WORD Modified
210388 CCC Partners Key Informant Interview Guide Form and Instruction Unchanged
210387 CCC Staff Key Informant Interview Guide Instruction Unchanged
210386 CCC Partners Key Informant Recruitment/Scheduling Form and Instruction Unchanged
210385 CCC Staff Key Informant Recruitment/Scheduling Form and Instruction Unchanged
210384 CCC Staff Key Informant Selection Form and Instruction Unchanged
210383 CCC Program Director Web Survey Questionnaire Form and Instruction Unchanged
ICR Details
0920-1016 201510-0920-001
Historical Active 201402-0920-012
HHS/CDC 15BGN
Experiences with the Implementation and Outcomes of Policy and Environmental Cancer Control Interventions
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 10/14/2015
Retrieve Notice of Action (NOA) 10/13/2015
  Inventory as of this Action Requested Previously Approved
05/31/2017 05/31/2017 05/31/2017
267 0 267
161 0 161
0 0 0
This is a new ICR, CDC plans to conduct a three-year mixed-methods study to collect information about the experiences and outcomes of state-based comprehensive cancer control (ccc) programs that are implementing policy, system and environmental (PSE) change strategies to address cancer prevention and control. Information will be collected from all 65 funded CCC programs, a subset of 13 CCC programs that recieved additional funding to enhance their PSE change strategies, and program partners and coalition members.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  78 FR 67 03/08/2013
78 FR 9054 02/07/2014
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 267 267 0 0 0 0
Annual Time Burden (Hours) 161 161 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$355,470
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.
10/13/2015