Palliative Care: Conversations Matter Phase Two Evaluation (NINR)

Forms and Documents

Document Name	Status
Form 1 Main Survey Form and Instruction	New
Form 1 Screener Form and Instruction	New
Form 1 Nurses Form and Instruction	Removed
Form 1 Physicians Form and Instruction	Removed
PIA_Phase Two Evaluation Survey 10 14 16.pdf Supplementary Document	2016-10-27
Attachment 6 Privacy Act Memo.pdf Supplementary Document	2016-10-27
30-day FRN2016-22998.pdf Supplementary Document	2016-09-26
Attachment 5 - IRB Exemption Email.pdf Supplementary Document	2016-09-13
Attachment 4 - Reminder Email.pdf Supplementary Document	2016-09-13
Attachment 3 - Survey Invitation Email.pdf Supplementary Document	2016-09-13
NINR_SuppStmtB_PhaseTwoEval_09_07_16.doc Supporting Statement B	2016-09-13
NINR_SuppStmtA_PhaseTwoEval_09_07_16.docx Supporting Statement A	2016-09-13

IC Document Collections

IC ID	Document Title	Status
223526	Main Survey Form and Instruction	New
223525	Screener Form and Instruction	New
208566	Nurses Form and Instruction	Removed
208565	Physicians Form and Instruction	Removed

ICR Details

OMB Control No: 0925-0683	ICR Reference No: 201609-0925-002
Status: Historical Inactive	Previous ICR Reference No: 201309-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No: 20361
Title: Palliative Care: Conversations Matter Phase Two Evaluation (NINR)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 03/17/2017
	Date Received in OIRA: 09/27/2016
Terms of Clearance: This ICR is being withdrawn from active review while the NIH and OMB determine the applicability of Section 2035 of Public Law No. 114-255 to this Federal collection (21st Century Cures Act, Sec. 2035: Exemption for the NIH from the Paperwork Reduction Act Requirements). At a later time point--after the NIH formally establishes the scope and criteria of collections that fall within the exemption as described in Section 2035--this ICR may be discontinued or re-submitted to OMB for PRA review/approval. At this time, no such determination of the applicability of Section 2035 has been made.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2016	36 Months From Approved	03/31/2017
Responses	600	0	600
Time Burden (Hours)	200	0	200
Cost Burden (Dollars)	0	0	0

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Abstract: In July 2015, NINR publically launched the second phase of the campaign, which focuses on patients and their families to raise awareness about the benefits of palliative care, empower families to begin a dialogue with health care providers, and seek out palliative care information and resources. The purpose and overall goal of the second phase of the Palliative Care: Conversations Matter® campaign is to increase the use of palliative care for children and teens living with serious illnesses. The purpose of the Palliative Care: Conversations Matter® Phase Two Evaluation is to measure the effectiveness of the second phase of the campaign and its educational materials.

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Authorizing Statute(s): US Code: 42 USC 285q Name of Law: National Institute of Nursing Research
  

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:
	81 FR 45169	07/12/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 65663	09/23/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Nurses	1	PRE AND POST SURVEYS
Physicians	1	PRE AND POST SURVEYS
Screener	1	Survey screenshot
Main Survey	1	Survey screenshot

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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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This is a revised information collection request to conduct an evaluation of the second phase of the Palliative Care: Conversations Matter® campaign, which involves collecting feedback from parents and caregivers to ensure that the second phase of the campaign is effective, relevant, and useful for this specific audience.

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Annual Cost to Federal Government: $43,750

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: 09/27/2016

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