Questionnaire Cognitive Interviewing and Pretesting (NCI)

ICR 201302-0925-007

OMB: 0925-0589

Federal Form Document

Forms and Documents
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Justification for No Material/Nonsubstantive Change
2013-02-22
Supplementary Document
2013-02-27
Supplementary Document
2013-02-27
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2013-02-27
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2013-02-27
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2013-02-27
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2013-02-27
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2013-02-27
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2013-02-27
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2013-02-27
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2013-02-27
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2013-02-27
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IC Document Collections
IC ID
Document
Title
Status
210644 New
210410 New
209051 New
208745 New
207597 New
205099 Modified
202800 Modified
200806 Modified
198056 Modified
ICR Details
0925-0589 201302-0925-007
Historical Active 201103-0925-004
HHS/NIH 18889
Questionnaire Cognitive Interviewing and Pretesting (NCI)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 03/04/2013
Retrieve Notice of Action (NOA) 02/28/2013
  Inventory as of this Action Requested Previously Approved
04/30/2014 04/30/2014 04/30/2014
4,800 0 3,600
6,000 0 3,600
0 0 0
A generic clearance is requested from OMB for general questionnaire development and pretesting activities to be carried out in 2011-2014 by the staff of the Applied Research Program, in the Division of Cancer Control and Population Sciences. Four types of activities will be carried out: survey questionnaire development and pretesting based on cognitive interviewing methodology, research on the cognitive aspects of survey methodology, research on computer-user interface design for computer-assisted instruments (including Web-based surveys), also known as Usability Testing, and Pilot Household interviews.
US Code: 42 USC 410 Name of Law: Public Health Service Act
   US Code: 42 USC 412 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  75 FR 79009 12/17/2010
76 FR 12979 03/09/2011
No
9
IC Title Form No. Form Name
Sub-study #9_Health Information National Trends Survey 4 (HINTS 4) Cog Test of Cycle 4 (Revised) 2, 1, 3, 4, 5, 6 Screener - Revised - English ,   Screener - Revised - Spanish ,   Consent Form - English ,   Consent Form - Spanish ,   Interview Protocol - English ,   Interview Protocol - Spanish
Sub-study #4: Cognitive Testing of the Family Life, Activity, Sun, Health, and Eating (FLASHE) Survey 2, 3, 4, 1, 5, 6, 7 Parent Diet and Demographic Survey ,   Parent Physical Activity Survey and Checklist ,   Teen Diet and Demographic Survey ,   FLASHE Screener ,   Teen Physical Activity Survey and Recall ,   Parent Cognitive Interview Guide ,   Teen Cognitive Interview Guide
Sub-study #5: Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of Cycle 3 Instrument 3, 2, 4, 1 Interview Protocol (English) ,   Screener (Spanish) ,   Interview Protocol (Spanish) ,   Screener (English)
Sub-study #7_Survey Instrument Designed to Assess Users' Perceptions of Website Changes 1 ARP Website Survey
Sub-study #10_Requirement Gathering for a Biobank Economic Modeling Tool (BEMT) 1, 2 Survey Screenshots ,   Follow-Up-Debriefing
Bundled Website Usability Testings #1 (ASA24) and #2 (GEM) 1, 2 #1_ASA 24 Screener and Guide ,   #2_GEM Attach 2C 2D Survey and Guide
Sub-study #3_Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of Cycle 2 Instrument 2, 1, 3 HINTS Cycle 2 Cognitive Interview Protocol ,   HINTS Cycle 2 Questionnaire ,   HINTS Cycle 2 Screener
Sub-study #6_Resubmission of Health Information National Trends Survey 4 (HINTS 4) Cognitive Testing of HINTS-FDA Instrument 4, 3, 1, 2 English Screener ,   Spanish Screener ,   Spanish Cognitive Interview Script ,   English Cognitive Interview Script
Sub-study #7_Development of Consensus Measures of Distress for the Grid Enabled Measures-Distress Measurement (GEM-DM) Workspace 1 GEM-DM Survey
  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 4,800 3,600 0 1,200 0 0
Annual Time Burden (Hours) 6,000 3,600 0 2,400 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
It is anticipated that a generic sub-study will be submitted shortly to request approval to perform formative research necessary to calibrate a self-report instrument to collect information relevant to Social Security Disability Insurance, from the NIH Clinical Center, and that testing is anticipated to require the use of approximately 2,200 hours. As a result, the program staff is asking for an increase in burden hours from 3,600 hours to 6,000 hours to accommodate this interest.
$244,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Mikia Currie 3014350941
  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.
02/28/2013
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