gc form 0530

SUBMISSION OF INFORMATION COLLECTION

UNDER GENERIC CLEARANCES

DATE OF REQUEST: _April 6, 2009___

SUB AGENCY (I/C): ___NCCAM____________

TITLE: ___Time to Talk about Complementary and Alternative Medicine Use________________

GENERIC CLEARANCE UNDER OMB# ­_0925-0530___ EXP. DATE: _10/31/2010_____

ABSTRACT:

Previous research has shown that communications practices between patients and health care providers regarding patients’ use of complementary and alternative medicine (CAM) are lacking. NCCAM is developing materials to address this gap.

This formative research survey will assess the communications practices between health care providers and their patients regarding CAM use. It will also pre-test three educational tools regarding the importance of discussing CAM use with patients, including two 1-page fact sheets and a wallet reference card.

We are seeking to implement this survey to physicians and nurse practitioners at the Society for General Internal Medicine’s 32^nd Annual Meeting and the American Academy of Nurse Practitioners 24^th National Conference, respectively. The survey will be administered at the NCCAM exhibit booth.

This effort is in accordance with the U.S. Senate Committee on Appropriations Committee Report on S. 3230:

“Communication Between Patients and Caregivers.—The Committee applauds NCCAM for its work to develop better strategies

for promoting communication between doctors and their patients who use CAM, especially adults over 50.”

TOTAL ANNUAL BURDEN APPROVED: _712_________

BURDEN USED TO DATE: ___40_______

BURDEN THIS REQUEST: _20_________

IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED?

___x___YES ______NO______N/A

OBLIGATION TO RESPOND:

__x____ VOLUNTARY

______ REQUIRED TO OBTAIN OR RETAIN BENEFITS

______ MANDATORY

HOW WILL THIS SURVEY BE OFFERED?

_____ WEB SITE

_____ TELEPHONE INTERVIEW

_____ MAIL RESPONSE

_____ IN PERSON INTERVIEW

__x___ OTHER: _self-administered questionnaire_________

CONTACT INFORMATION:

NAME: __ Alyssa Cotler _________________________________________

TELEPHONE NUMBER: _301-451-3851___________________________

EMAIL ADDRESS: _ cotlera@mail.nih.gov ________________________

* Revision of original approved on 1/08/2009