OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

The Centers for Disease Control and Prevention (CDC) Study on Disparities in Distress Screening among Lung and Ovarian Cancer Survivors

ICR 201906-0920-006 · OMB 0920-1270 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-19MM Focus Groups Form and Instruction New Repair queued
Form 0920-19MM Key Informant Interview Guide and Consent Form and Instruction New Available
Form 0920-19MM EHR Data Form and Instruction New Available
Privacy Narrative Cancer Distress Screening Final.pdf Supplementary Document Uploaded 2019-06-20 Available
Distress Screeening SSA final.doc Supporting Statement A Uploaded 2019-06-20 Available
Att 6a - Westat Continuing IRB Approval DS.pdf Supplementary Document Uploaded 2019-06-17 Repair queued
Att 6 - Westat Initial IRB Approval DS.pdf Supplementary Document Uploaded 2019-06-17 Available
Att 5c - FU email to schedule potential interviewees DS.docx Supplementary Document Uploaded 2019-06-17 Available
Att 5b - Email invitation to potential interviewees DS.docx Supplementary Document Uploaded 2019-06-17 Available
Att 5a - Int & focus grp respondent info form DS.docx Supplementary Document Uploaded 2019-06-17 Available
Att 3d - Healthcare facilities IRB info DS.docx Supplementary Document Uploaded 2019-06-17 Available
Att 3c - FAQs DS.docx Supplementary Document Uploaded 2019-06-17 Available
Att 3b - Initial recruitment email to study partners DS.docx Supplementary Document Uploaded 2019-06-17 Available
Att 3a - Initial recruitment email to potential healthcare facilities DS.docx Supplementary Document Uploaded 2019-06-17 Available
Att 2 60-day FRN DS.pdf Supplementary Document Uploaded 2019-06-17 Available
Att 1 - Authorizing Legislation DS.doc Supplementary Document Uploaded 2019-06-17 Available
Distress Screening SSB.docx Supporting Statement B Uploaded 2019-06-17 Available
IC Document Collections
IC IDCollectionTypeStatusForm
236527 Focus Groups Form and Instruction New
236526 Key Informant Interview Guide and Consent Form and Instruction New
236525 EHR Data Form and Instruction New
236524 Healthcare Professionals Survey Instruction New
ICR Details
0920-1270 201906-0920-006
Historical Active
HHS/CDC 0920-19MM
The Centers for Disease Control and Prevention (CDC) Study on Disparities in Distress Screening among Lung and Ovarian Cancer Survivors
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 10/09/2019
Retrieve Notice of Action (NOA) 07/05/2019
  Inventory as of this Action Requested Previously Approved
10/31/2020 12 Months From Approved
184 0 0
512 0 0
0 0 0
The purpose of this study is to examine the extent to which disparities exist in distress screening and follow-up care among cancer treatment facilities and programs across the country. CDC believes that it is imperative to develop a greater understanding about the types of services for lung and ovarian cancer survivors because they experience high levels of distress and are among those who experience the lowest 5-year survival rates.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  84 FR 8100 03/06/2019
84 FR 32179 07/05/2019
No
  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 184 0 0 184 0 0
Annual Time Burden (Hours) 512 0 0 512 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new collection
$142,077
Yes Part B of Supporting Statement
    No
    No
No
No
No
Uncollected
Kevin Joyce 404 639-1944 [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.
07/05/2019