Request for Approval

Request for genIC Approval

CDC/ATSDR Formative Research and Tool Development

0920-1154

CIO: NIOSH

PROJECT TITLE: Formative Assessment of the Information Needs to Prevent Skin Cancer Among Spanish Speaking Outdoor Workers

PURPOSE AND USE OF COLLECTION:

The purpose of conducting these formative research focus groups is to improve the researchers’ understanding of Spanish speaking outdoor workers’ knowledge of work-related sun exposure prevention and skin cancer risk. This information will be used internally to inform the development of draft educational materials and resources for Spanish speaking outdoor workers. No information will be collected that is of a personal or sensitive nature. The proposed information collection was reviewed by the NIOSH Division of Science Integration Associate Director for Science who determined that this is a non-research project and does not need further IRB review.

DESCRIPTION OF RESPONDENTS:

Respondents will be native Spanish speaking immigrant outdoor workers in the construction, landscaping, agricultural, and other industries, of either gender, age 18 years and older.

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. Information gathered will not be used to substantially inform influential policy decisions.

5. The study is not intended to produce results that can be generalized beyond its scope.

Name: ___ Michael Flynn___________________________

To assist review, please answer the following questions:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [X] Yes [ ] No

Focus group participants will be provided remuneration of $40 cash as an incentive to encourage participation.

BURDEN HOURS

Category of Respondent	Form Name	No. of Respondents	Participation Time	Burden
Private Sector (Spanish speaking outdoor workers)	Focus Group Guide	28	1.5 hr	42

FEDERAL COST: The estimated annual cost to the Federal government is $23,000.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe?

[X] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

NIOSH will rely on the contractor [Communidades Unidas] to identify native Spanish speaking outdoor workers from their clients/members. Once potential respondents are identified, the contractor will make phone calls to explain the purpose of the research, identify if the contact meets the NIOSH study criteria (i.e., 18 years or older, affiliates of the organization), and determine if the individual is interested in participating in a focus group discussion. If agreeable, the individual will be given details about the focus group time and location.

It is important to note that participation will be completely voluntary and respondents have the right to not answer any question or withdraw from the focus group discussion at any time. No personally identifying information will be collected, nor will responses be attributed to specific individuals in the information provided to NIOSH.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[X] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X] Yes [ ] No

Please make sure all instruments, instructions, and scripts are submitted with the request.

Instructions for completing genIC Request for Approval for CDC/ATSDR

Formative Research and Tool Development

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is requested.

PURPOSE and USE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Briefly describe the targeted group/groups for this collection.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households; (2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected.

Form: Provide the title of the information collection form.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group).

Burden in Minutes: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Estimate the annual cost to the Federal government for this collection.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

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