Calibration II & Predictive Validity Testing of Item Response Theory – Computer Adaptive Testing Tools (IRT-CAT)

Forms and Documents

Document Name	Status
Form 9 Normative Population Survey 1 Form and Instruction	New
Form 10 Normative Population Survey 2 Form and Instruction	New
Form 8 Claimant Survey 2 Form and Instruction	New
Form 7 Survey 2 Claimant Consent Form Form and Instruction	New
Form 6 Survey 1 Claimant Consent Form Form and Instruction	New
Form 5 Claimant Survey 1 Form and Instruction	New
Form 4 Survey 2 - Screener Call (Participate/Eligible) Form and Instruction	New
Form 3 Survey 2 Screener Call (Not Interested) Form and Instruction	New
Form 2 Survey 1 - Screener Call (Participate/Eligible) Form and Instruction	New
Form 1 Survey 1- Screener Call (not interested) Form and Instruction	New
Support Statement A_CAT Instruments_FINAL SUBMISSION.doc Supporting Statement A	2014-08-14
Support Statement B_CAT Instruments.doc Supporting Statement B	2014-08-13
Attachment 11_Authorization to Operate.pdf Supplementary Document	2014-08-13
Attachment 14_NIH IRB Approval_Reliance Agreement.pdf Supplementary Document	2014-08-11
Attachment 13_Intstitutional Review Board Approval.pdf Supplementary Document	2014-08-11
Attachment 12_NIH Privacy Impact Assessment.pdf Supplementary Document	2014-08-11
Attachment 10_Westat Media Sanitization & Disposal Policy.pdf Supplementary Document	2014-08-11
Attachment 1_Authorizing Legislation.pdf Supplementary Document	2014-08-11

IC Document Collections

IC ID	Document Title	Status
212694	Normative Population Survey 1 Form and Instruction	New
212661	Normative Population Survey 2 Form and Instruction	New
212659	Claimant Survey 2 Form and Instruction	New
212658	Survey 2 Claimant Consent Form Form and Instruction	New
212657	Survey 1 Claimant Consent Form Form and Instruction	New
212656	Claimant Survey 1 Form and Instruction	New
212639	Survey 2 - Screener Call (Participate/Eligible) Form and Instruction	New
212637	Survey 2 Screener Call (Not Interested) Form and Instruction	New
212636	Survey 1 - Screener Call (Participate/Eligible) Form and Instruction	New
212634	Survey 1- Screener Call (not interested) Form and Instruction	New

ICR Details

OMB Control No: 0925-0704	ICR Reference No: 201408-0925-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Calibration II & Predictive Validity Testing of Item Response Theory – Computer Adaptive Testing Tools (IRT-CAT)
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: 10/03/2014
	Date Received in OIRA: 09/04/2014
Terms of Clearance: Approval for phases 2 through 4 is not granted at this time. Once NIH has developed the instruments for each phase, NIH must submit a non-substantive change prior to initiating the data collection for that phase.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	36 Months From Approved
Responses	40,500	0	0
Time Burden (Hours)	12,835	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Institutes of Health, Clinical Center, Rehabilitation Medicine Department seeks OMB clearance to conduct calibration, predictive validity and validation studies on Computer Adaptive Tests currently under development under an Interagency Agreement with the Social Security Administration to improve the Disability Insurance Program.

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Authorizing Statute(s): US Code: 42 USC 1310(a) Name of Law: Social Security 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:
	79 FR 77	04/22/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 153	08/08/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 10

IC Title	Form No.	Form Name
Normative Population Survey 1	9	Normative Survey 1
Survey 1 Claimant Consent Form	6	Claimant Survey 1 Consent Form
Survey 2 Claimant Consent Form	7	Survey 2 Claimant Consent Form
Claimant Survey 2	8	Survey 2 Replinishment Items and Short Forms
Normative Population Survey 2	10	Normative Survey 2
Claimant Survey 1	5	Complete Item Bank Survey 1
Survey 2 Screener Call (Not Interested)	3	Survey 2 Claimant Screener script
Survey 2 - Screener Call (Participate/Eligible)	4	Survey 2 Claimant Screener
Survey 1- Screener Call (not interested)	1	Claimant Screener Survey 1
Survey 1 - Screener Call (Participate/Eligible)	2	Claimant Screener Script Survey 1(participate)

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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	40,500	0	0	40,500	0	0
Annual Time Burden (Hours)	12,835	0	0	12,835	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: New ICR

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Annual Cost to Federal Government: $2,179,419

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 09/04/2014

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