Be the Match® Patient Services Survey

Forms and Documents

Document Name	Status
Form 1 Patient Services Survey Form and Instruction	Modified
OMB Non-Substantive Change Request - OMB 0906-0004 - 06302025.docx Justification for No Material/Nonsubstantive Change	2025-06-30
01232023 Email Invite Spanish - OPA Patient Support Center Survey OMB 0906-0004.docx Supplementary Document	2023-06-14
01232023 Email Invite English - OPA Patient Support Center Survey OMB 0906-0004.docx Supplementary Document	2023-06-14
06012023 - Supporting Statement A - OPA PSC Survey - OMB 0906-0004.docx Supporting Statement A	2023-06-14

IC Document Collections

IC ID	Document Title	Status
213555	Patient Services Survey Form and Instruction	Modified

ICR Details

OMB Control No: 0906-0004	ICR Reference No: 202506-0906-005
Status: Received in OIRA	Previous ICR Reference No: 202306-0906-001
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Be the Match® Patient Services Survey
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/02/2025

	Requested	Previously Approved
Expiration Date	10/31/2026	10/31/2026
Responses	900	900
Time Burden (Hours)	153	153
Cost Burden (Dollars)	0	0

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Abstract: The CWBYCTP’s Office of Patient Advocacy (OPA) is operated by the National Marrow Donor Program® (NMDP). Through the OPA, NMDP provides navigation services, education resources, and support to people in need of an allogeneic hematopoietic cell transplant (allo-HCT). As the contractor for the OPA, NMDP is required to conduct surveys to evaluate patient satisfaction with the services provided. As such, NMDP will elicit feedback from all HCT patients, caregivers, and family members who had contact with the NMDP/Be The Match® Patient Support Center (PSC) for service and support (advocacy). Survey results will be used to inform program development and resource allocation decisions.

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Authorizing Statute(s): PL: Pub.L. 111 - 264 3 Name of Law: Stem Cell Therapeutic and Research Reauthorization Act of 2010
  

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:
	88 FR 13130	03/02/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 38872	06/14/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Patient Services Survey	1, 2	OPA PSC Survey English ,   OPA PSC Survey - Spanish

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ICR Summary of Burden

	Total Request	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	900	900	0	0	0	0
Annual Time Burden (Hours)	153	153	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $6,903

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 07/02/2025

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