Evaluation of Cancer Control Leadership Forums at the Center for Global Health (CGH) (NCI)

Forms and Documents

Document Name	Status
Form 5 Leadership Forum 24 Month Post Interview Form	New
Form 4 Leadership Forum 12 month Post Interview Form	New
Form 3 6 Month Post Workshop Interview Form	New
Form 2 Leadership Forum 3 month Post Workshop Interview Form	New
Form 1 Leadership Forum 3 month Pre-Assessment Form and Instruction	New
Attachment 4 Invitation.docx Supplementary Document	2014-11-12
Attachment 3 OHSRP Exemption.pdf Supplementary Document	2014-11-12
Attachment 2 Privacy Act Memo.pdf Supplementary Document	2014-11-12
SSB_LeadForum 8.15.2014.docx Supporting Statement B	2014-11-12
SSA_Leadership Forum 11.12.14.docx Supporting Statement A	2014-11-12

IC Document Collections

IC ID	Document Title	Status
213896	Leadership Forum 24 Month Post Interview Form	New
213894	Leadership Forum 12 month Post Interview Form	New
213893	6 Month Post Workshop Interview Form	New
213838	Leadership Forum 3 month Post Workshop Interview Form	New
213837	Leadership Forum 3 month Pre-Assessment Form and Instruction	New

ICR Details

OMB Control No: 0925-0708	ICR Reference No: 201411-0925-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Evaluation of Cancer Control Leadership Forums at the Center for Global Health (CGH) (NCI)
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: 12/23/2014
	Date Received in OIRA: 11/19/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved
Responses	90	0	0
Time Burden (Hours)	108	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This submission is a request for OMB to approve the Evaluation of the Cancer Control Leadership Forums at the Center for Global Health (CGH) for three years. These workshops are organized and funded by the National Cancer Institute's CGH in conjunction with various partners ranging from foreign Ministries of Health and research institutions, to international non-governmental organizations (NGOs) and U.S. academic institutions. The goal of the U.S. National Cancer Institute (NCI) Cancer Control Leadership Forums is to increase the capacity of participating countries to initiate or enhance cancer control planning and implementation in their respective countries. The Forums are an opportunity for countries to exchange experiences and ideas about creating and implementing comprehensive cancer control plans.

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Authorizing Statute(s): US Code: 42 USC section 285 Name of Law: Public Health Service 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 41295	07/15/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 222	11/18/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Leadership Forum 3 month Post Workshop Interview	2	3 month Post Workshop Interview
6 Month Post Workshop Interview	3	Leadership Forum 6 Month Post Interview
Leadership Forum 3 month Pre-Assessment	1	Leadership Forum 3 month Pre-Assessment
Leadership Forum 24 Month Post Interview	5	Leadership Forum 24 Month Post Interview
Leadership Forum 12 month Post Interview	4	Leadership Forum 12 Month Post Interview

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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	90	0	0	90	0	0
Annual Time Burden (Hours)	108	0	0	108	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 submission

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Annual Cost to Federal Government: $17,984

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: 11/19/2014

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