National Physician Survey of Practices on Diet, Physical Activity, and Weight Control(NCI)

Forms and Documents

Document Name	Status
OMB Memo Nonsubstantive Change Physician Survey on diet PA wt 7-08.doc Justification for No Material/Nonsubstantive Change	2008-08-07
FAQs for EBalance5 09-07.doc Supplementary Document	2007-09-24
Letter to Admin for AdminSurvey 09-14-07.doc Supplementary Document	2007-09-24
FINALLetter to Physicians for EB Provider Survey RBB 09-14-07.doc Supplementary Document	2007-09-24
Attachment 2 Privacy Act Statement.pdf Supplementary Document	2007-09-05
Attachment 3b SmithA_NCI_Exempt_3827_CY2007.pdf Supplementary Document	2007-09-05
Attachment 3a Documentation of IRB Approval.pdf Supplementary Document	2007-09-05
Attachment 5 Klabunde et al.pdf Supplementary Document	2007-09-05

IC Document Collections

IC ID	Document Title	Status
182207	Questionnaires, Scripts, and Letters Instruction	Modified

ICR Details

OMB Control No: 0925-0583	ICR Reference No: 200809-0925-001
Status: Historical Active	Previous ICR Reference No: 200710-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: National Physician Survey of Practices on Diet, Physical Activity, and Weight Control(NCI)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/27/2008
	Date Received in OIRA: 09/02/2008
Terms of Clearance: Prior terms of clearance continue. Please report back to OMB on the extent to which the additon of fax and email addresses improves response.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2010	12/31/2010	12/31/2010
Responses	4,000	0	4,000
Time Burden (Hours)	1,320	0	1,320
Cost Burden (Dollars)	0	0	0

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Abstract: This is a survey of 4,000 primary care physicians to learn their attitudes and practices related to disseminating information about healthy behaviors and disease prevention involving diet, physical activity, and weight control, also known as energy balance.

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Authorizing Statute(s): US Code: 42 USC 285 Name of Law: Purpose of the National Cancer Institute
  

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 35499	06/28/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 50376	08/31/2007
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
Questionnaires, Scripts, and Letters	1	All Questionaires

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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	4,000	4,000	0	0	0	0
Annual Time Burden (Hours)	1,320	1,320	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $257,700

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: 09/02/2008

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