Short Follow-Up Questionnaire 2008 in the Prospective Cohort Study of Diet and Cancer in Members of the American Association of Retired Persons: The NIH-AARP Diet and Health Study (NCI)

Forms and Documents

Document Name	Status
Form 1 The 2008 Short Questionnaire for the NIH-AARP Diet and Health Study Form	New
SSB_10-15-07.doc Supporting Statement B	2007-12-10
Cover Memo October 2007.pdf Supplementary Document	2007-12-10
Att9-4_Wave 4 Mailing Follow-up letter.pdf Supplementary Document	2007-12-10
Att9-3_Wave 3 Mailing Follow-up letter.pdf Supplementary Document	2007-12-10
Att9-2_Wave 2 Mailing Follow-up letter.pdf Supplementary Document	2007-12-10
Att9-1_Wave 1 Mailing Follow-up letter.pdf Supplementary Document	2007-12-10
Att8_NCI IRB Approval.pdf Supplementary Document	2007-12-10
Att7_Confidentiality Procedures Westat.pdf Supplementary Document	2007-12-10
Att6_Privacy Act Memo.pdf Supplementary Document	2007-12-10
Att5_External Working Group.pdf Supplementary Document	2007-12-10
Att4_Steering Committee.pdf Supplementary Document	2007-12-10
Att1_Original Study Protocol Summary.pdf Supplementary Document	2007-12-10
Att3_Bibliography.pdf Supplementary Document	2007-12-10
SSA_01-31-08.doc Supporting Statement A	2008-01-31

IC Document Collections

IC ID	Document Title	Status
183704	The 2008 Short Questionnaire for the NIH-AARP Diet and Health Study Form	New

ICR Details

OMB Control No: 0925-0587	ICR Reference No: 200802-0925-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Short Follow-Up Questionnaire 2008 in the Prospective Cohort Study of Diet and Cancer in Members of the American Association of Retired Persons: The NIH-AARP Diet and Health Study (NCI)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/24/2008
	Date Received in OIRA: 02/06/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2011	36 Months From Approved
Responses	513,225	0	0
Time Burden (Hours)	34,215	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Short Follow-Up Questionnaire is needed in order to obtain information on selected medical conditions, medical procedures, and physical and lifestyle status from 513,225 participants in the NIH-AARP Diet and Health Study cohort. The information will be used for the ongoing examination between health and lifestyle behaviors and cancer.

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Authorizing Statute(s): US Code: 42 USC 412 (285a-1) Name of Law: Public Health Service Act
   US Code: 42 USC 413 (285a-2) Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 62660	11/06/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 4594	01/25/2008
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
The 2008 Short Questionnaire for the NIH-AARP Diet and Health Study	1	NIH-AARP Short Questionnaire 2008

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ICR Summary of Burden

	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	513,225	0	0	513,225	0	0
Annual Time Burden (Hours)	34,215	0	0	34,215	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection.

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Annual Cost to Federal Government: $91,500

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/06/2008

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