OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

ASSESSMENT OF CANCER PREVENTION SERVICES AT COMMUNITY MENTAL HEALTH CENTERS

ICR 201802-0920-011 · OMB 0920-1229 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Administrator Interview Form and Instruction New Available
Clinician Interview Form and Instruction New Available
Administrator Survey Instrument Form and Instruction New Available
Clinical Survey Instrument Form and Instruction New Repair queued
CMHC_OMB_SSB_080317.docx Supporting Statement B Uploaded 2018-02-27 Available
CMHC_OMB_SSA_02012018.docx Supporting Statement A Uploaded 2018-02-27 Available
CMHC_OMB_APPENDIX 2b_Summary of Comments.pdf Supplementary Document Uploaded 2018-02-27 Available
CMHC_OMB_SSA_APPENDIX 9_Clinician and Administrator Pilot Feedback Forms 080317.docx Supplementary Document Uploaded 2018-02-27 Repair queued
CMHC_OMB_SSA_APPENDIX 8_Consent Materials 080317.docx Supplementary Document Uploaded 2018-02-27 Repair queued
CMHC_OMB_SSA_APPENDIX 7_Web Pages_080317.docx Supplementary Document Uploaded 2018-02-27 Available
CMHC_OMB_SSA_APPENDIX 6_Recruitment Materials_080317.docx Supplementary Document Uploaded 2018-02-27 Available
CMHC_OMB_SSA_APPENDIX 3_IRB Approval 080317.docx Supplementary Document Uploaded 2018-02-27 Available
60d FRN 82FR51837.pdf Supplementary Document Uploaded 2018-02-27 Available
CMHC_OMB_SSA_APPENDIX 1_Authorizing Legislation 080317.pdf Supplementary Document Uploaded 2018-02-27 Available
IC Document Collections
IC IDCollectionTypeStatusForm
230270 Administrator Interview Form and Instruction New
230269 Clinician Interview Form and Instruction New
230268 Administrator Survey Instrument Form and Instruction New
230267 Clinical Survey Instrument Form and Instruction New
ICR Details
0920-1229 201802-0920-011
Historical Active
HHS/CDC 0920-17AZG
ASSESSMENT OF CANCER PREVENTION SERVICES AT COMMUNITY MENTAL HEALTH CENTERS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 05/11/2018
Retrieve Notice of Action (NOA) 03/02/2018
  Inventory as of this Action Requested Previously Approved
05/31/2020 24 Months From Approved
1,100 0 0
392 0 0
0 0 0
People with mental illness have increased risk behaviors for cancer such as smoking and lack of physical activity; however, they are less likely to receive cancer screening than persons without mental illness. Many people with mental illness receive outpatient mental health care at community mental health centers, some of which also offer screening for chronic conditions. This study will examine the capacities of community mental health centers to provide cancer prevention services, which is not well understood., and will assess barriers and facilitators to providing cancer prevention services at community mental health centers (CMHCS) in the United States. The study will conduct two surveys of psychiatric clinicians and administrators at selected facilities. Findings will be disseminated to target audiences such as National Comprehensive Cancer Control Program grantees and their state/local partners, other cancer prevention and control entities, and CMHC staff to help inform strategies that reduce cancer risk factors and improve cancer screening among persons with mental illness.
US Code: 42 USC 241 Name of Law: U.S. PHSA
  
None
Not associated with rulemaking
  82 FR 51837 11/08/2017
83 FR 8874 03/01/2018
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 1,100 0 0 1,100 0 0
Annual Time Burden (Hours) 392 0 0 392 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Submission of 0920-17AZG - ASSESSMENT OF CANCER PREVENTION SERVICES AT COMMUNITY MENTAL HEALTH CENTERS is a New Information Collection Request.
$284,336
No
    No
    No
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 [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.
03/02/2018