Survey of NHLBI Constituents Health Information Needs and Preferred Formats

Forms and Documents

Document Name	Status
Form 1 HIC General Survey Form and Instruction	New
HIC General Survey Supporting Statement B_052009.docx Supporting Statement B	2009-05-22
HIC General Survey NIH Privacy Act Officer Memo COPY.doc Supplementary Document	2009-05-22
HIC General Survey Attachment C_052009.docx Supplementary Document	2009-05-22
HIC General Survey Attachment B_052009.docx Supplementary Document	2009-05-22
HIC General Survey Supporting Statement A_052009.docx Supporting Statement A	2009-05-22

IC Document Collections

IC ID	Document Title	Status
189721	HIC General Survey Form and Instruction	New

ICR Details

OMB Control No: 0925-0603	ICR Reference No: 200906-0925-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Survey of NHLBI Constituents Health Information Needs and Preferred Formats
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: 09/15/2009
	Date Received in OIRA: 06/25/2009
Terms of Clearance: Approved with the understanding that the results will be based on a convenience sample of respondents and that the results of this study will not be the sole or even primary guideline for determining the direction for investment in new NHLBI materials.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2012	36 Months From Approved
Responses	809	0	0
Time Burden (Hours)	162	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The NHLBI seeks to collect data from NHLBI constituents (health professionals, patients and their families, and the general public) for the purpose of evaluating their health information and education needs and format preferences and to create new information materials for NHLBI constituents.

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Authorizing Statute(s): US Code: 42 USC 285b Name of Law: NHLBI Information and Education
  

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:
	74 FR 11736	03/19/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 26243	06/01/2009
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
HIC General Survey	1	General Survey

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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	809	0	0	809	0	0
Annual Time Burden (Hours)	162	0	0	162	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 ICR.

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Annual Cost to Federal Government: $40,492

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)? No

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: 06/25/2009

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