Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Document Name	Status
Form 1 Satisfaction with Kenya Cancer Control and Cancer Research Stakeholder Meeting Form	New
Form 1 Sub-study #38_Cancer Control Leadership Forum CCLF Form	New
Form 1 Sub-study #37_Revised Satisfaction Survey for the Symposium on Global Cancer Research 2014 Form and Instruction	New
Form 1B #36 Clinical Proteomic Tumor Analysis Consortium (CPTAC) Surveys Form and Instruction	New
Form 2 Sub-study #35_Cognitive Interviewing for Item Bank in Computer Adaptive Testing Instrument Form and Instruction	New
Form 1 Sub-study #34_NCI Office of Cancer Nanotechnology Laboratory (caNanoLab) Survey Form and Instruction	New
Form 1 Sub-study #33_User Simulation Study for NIH-SSA Collaboration to Improve Disability Determination (Revised) Form and Instruction	New
Form 1 Sub-study #32_Protocol and Information Office (PIO) External Customer Satisfaction Survey Form and Instruction	New
Form 1 Sub-study #29_Satisfaction with Global Cancer Research Day 2013 Form and Instruction	New
Form 1 Sub-study #28_Customer Satisfaction and Feedback about the NCI Best Practices for Biospecimen Resources Form and Instruction	New
Form 1 Sub-study #27_Satisfaction with Cancer Research Programs in Underserved Communities (CGH) Form and Instruction	New
Form 1 REVISED Sub-study #25_ Center for Cancer Training (CCT) Web Site Usability Testing Form and Instruction	New
Form 1 Sub-study #24 - Needs Assessment for the NCI Office of Cancer Survivorship's Web site (OCS) Form and Instruction	New
Form 1 Sub-study #26_Life in A Day Phone Application Study (Usability Study) Form and Instruction	New
Form 1 Sub-study #23 NCCOR Website Usability Testing Form and Instruction	New
Form 1 Bundled Sub-studies #20, #21 and #22 Website Usability Testing Form and Instruction	New
Form 1 Sub-study #19_Epidemiology and Genomics Research Program (EGRP) Communications Survey Form and Instruction	New
Form 1 Sub-study #18_Cancer Imaging Program (CIP) Web Site Usability Testing Form and Instruction	New
Form 1 Sub-Study #16 - International Focus Group to Inform Economic Barriers and Challenges to Biobankers Form and Instruction	New
Form 1 Sub-Study #15: The Surveillance, Epidemiology, and End Results (SEER) Residual Tissue Repository Program: Survey to Assess Service Delivery and Product Quality Form and Instruction	New
Form 1 Sub-study #14 - CCR Clinical Trials at NIH - Join Our Mailing List/Update Your Profile Business Contact Information Form and Instruction	New
Form 1 Sub-study #13 - Focus Groups to Assess Implementation of the NCCCP-developed Template for Community Outreach (TCO) Form and Instruction	New
Form 2 Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12) Form and Instruction	New
Form 1 Sub-Study #9 & #10 - HD*Calc Customer Satisfaction Survey for Different Category of Respondents: State (#9) and Federal Respondents (#10) Form and Instruction	New
Form 1 Sub-study #8_HD*Calc Customer Satisfaction Survey for Private Sector Respondents Form and Instruction	New
Form 3E Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey Form and Instruction	New
Form 1 Sub-study #4_Multi-Part Plan for Research and Development of the Solar Cell Mobile Application Form and Instruction	New
Form 2.1 and 2.5 Revised Bundled Sub-study #2 and #3_Usability Testing for DCEG Newsletter Linkage and SEER Consolidated Cancer Statistics Tool Form and Instruction	New
Form 1A Sub-study #1_The Cancer Genome Atlas (TCGA) Data User Platform Survey Form and Instruction	New
Draft Generic Clearance Submission Template[1].docx Supplementary Document	2011-09-15
SSB Generic NCI Fast Track.docx Supporting Statement B	2011-08-10
SSA Generic NCI Fast Track.docx Supporting Statement A	2011-08-10

IC Document Collections

IC ID	Document Title	Status
211385	Satisfaction with Kenya Cancer Control and Cancer Research Stakeholder Meeting Form	New
210968	Sub-study #38_Cancer Control Leadership Forum CCLF Form	New
210407	Sub-study #37_Revised Satisfaction Survey for the Symposium on Global Cancer Research 2014 Form and Instruction	New
210298	#36 Clinical Proteomic Tumor Analysis Consortium (CPTAC) Surveys Form and Instruction	New
209773	Sub-study #35_Cognitive Interviewing for Item Bank in Computer Adaptive Testing Instrument Form and Instruction	New
209600	Sub-study #34_NCI Office of Cancer Nanotechnology Laboratory (caNanoLab) Survey Form and Instruction	New
209220	Sub-study #33_User Simulation Study for NIH-SSA Collaboration to Improve Disability Determination (Revised) Form and Instruction	New
208300	Sub-study #32_Protocol and Information Office (PIO) External Customer Satisfaction Survey Form and Instruction	New
207182	Sub-study #29_Satisfaction with Global Cancer Research Day 2013 Form and Instruction	New
206942	Sub-study #28_Customer Satisfaction and Feedback about the NCI Best Practices for Biospecimen Resources Form and Instruction	New
206877	Sub-study #27_Satisfaction with Cancer Research Programs in Underserved Communities (CGH) Form and Instruction	New
206754	REVISED Sub-study #25_ Center for Cancer Training (CCT) Web Site Usability Testing Form and Instruction	New
206546	Sub-study #24 - Needs Assessment for the NCI Office of Cancer Survivorship's Web site (OCS) Form and Instruction	New
206211	Sub-study #26_Life in A Day Phone Application Study (Usability Study) Form and Instruction	New
205913	Sub-study #23 NCCOR Website Usability Testing Form and Instruction	New
205388	Bundled Sub-studies #20, #21 and #22 Website Usability Testing Form and Instruction	New
205174	Sub-study #19_Epidemiology and Genomics Research Program (EGRP) Communications Survey Form and Instruction	New
205054	Sub-study #18_Cancer Imaging Program (CIP) Web Site Usability Testing Form and Instruction	New
204499	Sub-Study #16 - International Focus Group to Inform Economic Barriers and Challenges to Biobankers Form and Instruction	New
203874	Sub-Study #15: The Surveillance, Epidemiology, and End Results (SEER) Residual Tissue Repository Program: Survey to Assess Service Delivery and Product Quality Form and Instruction	New
203094	Sub-study #14 - CCR Clinical Trials at NIH - Join Our Mailing List/Update Your Profile Business Contact Information Form and Instruction	New
202647	Sub-study #13 - Focus Groups to Assess Implementation of the NCCCP-developed Template for Community Outreach (TCO) Form and Instruction	New
202292	Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12) Form and Instruction	New
202114	Sub-Study #9 & #10 - HD*Calc Customer Satisfaction Survey for Different Category of Respondents: State (#9) and Federal Respondents (#10) Form and Instruction	New
201596	Sub-study #8_HD*Calc Customer Satisfaction Survey for Private Sector Respondents Form and Instruction	New
201419	Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey Form and Instruction	New
200992	Sub-study #4_Multi-Part Plan for Research and Development of the Solar Cell Mobile Application Form and Instruction	New
200808	Revised Bundled Sub-study #2 and #3_Usability Testing for DCEG Newsletter Linkage and SEER Consolidated Cancer Statistics Tool Form and Instruction	New
199727	Sub-study #1_The Cancer Genome Atlas (TCGA) Data User Platform Survey Form and Instruction	New

ICR Details

OMB Control No: 0925-0642	ICR Reference No: 201108-0925-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
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: 09/20/2011
	Date Received in OIRA: 08/16/2011
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2014	36 Months From Approved
Responses	6,500	0	0
Time Burden (Hours)	8,750	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable NIH to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with NIH's programs.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: SETTING CUSTOMER SERVICE STANDARDS
  

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:
	75 FR 80542	12/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 44938	07/27/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 29

IC Title	Form No.	Form Name
Sub-study #33_User Simulation Study for NIH-SSA Collaboration to Improve Disability Determination (Revised)	1, 2, 3, 4	Item Bank Behavioral Health Questions ,   Item Bank Physical Function Questions ,   Initial Screenshot of CAT ,   Debriefing Interview for Feds
Sub-Study #15: The Surveillance, Epidemiology, and End Results (SEER) Residual Tissue Repository Program: Survey to Assess Service Delivery and Product Quality	1	RTR Survey
Sub-study #1_The Cancer Genome Atlas (TCGA) Data User Platform Survey	1A	TCGA Email and Survey
Bundled Sub-studies #20, #21 and #22 Website Usability Testing	1, 2, 3, 4, 5, 6	CPCC #20 Screener ,   CPCC #20 Facilitator's Guide ,   DCPDIV #21 Screener ,   DCPDIV #21 Facilitator's Guide ,   DCP NSRG Screener ,   DCP NSRG Facilitator's Guide
Sub-study #8_HD*Calc Customer Satisfaction Survey for Private Sector Respondents	1	Full Survey with Skips
Sub-study #32_Protocol and Information Office (PIO) External Customer Satisfaction Survey	1	PIO Survey
Sub-study #34_NCI Office of Cancer Nanotechnology Laboratory (caNanoLab) Survey	1	Survey
Satisfaction with Kenya Cancer Control and Cancer Research Stakeholder Meeting	1	Screenshots of CGH Kenya Survey
Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)	1, 2, 3, 4, 5	Follow-Up Survey_Portuguese ,   Follow-Up Survey_English ,   Follow-Up Survey_Spanish ,   #12 Smokefree.gov Screenshots Part 1 ,   #12 Smokefree.gov Screenshots Part 2
Sub-study #35_Cognitive Interviewing for Item Bank in Computer Adaptive Testing Instrument	2, 1	Consent Form ,   Moderator's Guide
Sub-study #28_Customer Satisfaction and Feedback about the NCI Best Practices for Biospecimen Resources	1	BBRB Standards Survey
REVISED Sub-study #25_ Center for Cancer Training (CCT) Web Site Usability Testing	1, 2	CCT Screener ,   CCT Usability Script
Sub-study #26_Life in A Day Phone Application Study (Usability Study)	1, 2, 3	Screener_Life ,   Day 1 Script ,   Day 3 Script
Sub-study #37_Revised Satisfaction Survey for the Symposium on Global Cancer Research 2014	1	CGH Meeting Survey
Revised Bundled Sub-study #2 and #3_Usability Testing for DCEG Newsletter Linkage and SEER Consolidated Cancer Statistics Tool	2.1 and 2.5, 3A and 3B, 3C, 3E, 3D, 3F	DCEG Facilitator's Guide and System Usability Scale ,   SEER Screener for HC Prof and Public ,   SEER Moderator Guide for Public ,   SEER Moderator Guide for Researcher ,   SEER Moderator Guide for HC Professionals ,   SEER Moderator Guide for Media
Sub-study #18_Cancer Imaging Program (CIP) Web Site Usability Testing	1, 2	Screener ,   Usability Test
#36 Clinical Proteomic Tumor Analysis Consortium (CPTAC) Surveys	1B, 2B	TCGA Survey Screenshots ,   CPTAC Survey screenshots
Bundled Sub-studies #5 DCP Survey, #6 R2R Survey, and #7 PS-OC Survey	1, 2, 3A, 3B, 3C, 3D, 3E, 3F, 3H, 3G	#7_Attach2E_Outreach ,   #7_Attach2F_Advocates ,   #7_Attach2B_Education ,   #7_Attach2C_Principal ,   #7_Attach2D_Project Investigators ,   DCP Survey Screenshots ,   R2R Survey ,   #7_Attach 2A_Administrators ,   #7_Attach2H_Trainees ,   #7_Attach2G_Advisors
Sub-study #29_Satisfaction with Global Cancer Research Day 2013	1	CGH Global Meeting Survey
Sub-Study #16 - International Focus Group to Inform Economic Barriers and Challenges to Biobankers	1	Moderator's Guide
Sub-study #27_Satisfaction with Cancer Research Programs in Underserved Communities (CGH)	1	Facilitator Conducted Survey
Sub-Study #9 & #10 - HD*Calc Customer Satisfaction Survey for Different Category of Respondents: State (#9) and Federal Respondents (#10)	1	HD Calc Survey
Sub-study #38_Cancer Control Leadership Forum CCLF	1	Cancer Control Leadership Forum Survey
Sub-study #23 NCCOR Website Usability Testing	1, 2, 3	Facilitator's Guide - Catalogue ,   Facilitator's Guide - Measures ,   Recruit Phone Call
Sub-study #19_Epidemiology and Genomics Research Program (EGRP) Communications Survey	1	EGRP Listserv Survey
Sub-study #14 - CCR Clinical Trials at NIH - Join Our Mailing List/Update Your Profile Business Contact Information	1, 2	Join CCR Mailing List ,   Update CCR Mailing List
Sub-study #13 - Focus Groups to Assess Implementation of the NCCCP-developed Template for Community Outreach (TCO)	1	Moderator's Guide
Sub-study #4_Multi-Part Plan for Research and Development of the Solar Cell Mobile Application	3, 1, 4, 5, 2	Attach 2 Beta Test Screen & Survey ,   Attach 6 Focus Group Screen & Questions ,   Attach 8 MP Interviews Guide & Questions ,   Attach 4 CogInterview Screen & Pre-and Post-tests ,   Attach 10 Use Test Interview Guide & Questions
Sub-study #24 - Needs Assessment for the NCI Office of Cancer Survivorship's Web site (OCS)	1, 2, 3	OCS Screener for Public ,   OCS Screener for Professionals ,   Facilitator's Guides for All Groups

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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	6,500	0	0	6,500	0	0
Annual Time Burden (Hours)	8,750	0	0	8,750	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: Not applicable. This is a new request for a generic ICR.

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Annual Cost to Federal Government: $300,000

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: 08/16/2011

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