Information Collection Request

[NCCDPHP] Evaluation of a Prostate Cancer Decision Aid

ICR 202407-0920-009 · OMB 0920-1438 · Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-1438 can be found here:

2025-05-14 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document Name	Status
Form 0920-24CB Pre-exposure Survey Form	New
Form 0920-24CB Pre-exposure Survey Form	New
Form 0920-24CB Patient Eligibility Screener Form	New
Form 0920-24CB Patient Eligibility Screener Form	New
Form 0920-24CB Provider Survey Form	New
Form 0920-24CB Provider Survey Form	New
Form 0920-24CB Clinic Coordinator Interview Form	New
Form 0920-24CB Clinic Coordinator Interview Form	New
Form 0920-24CB Post-clinic Survey Form	New
Form 0920-24CB Post-clinic Survey Form	New
Form 0920-24CB User Experience Interview Form	New
Form 0920-24CB User Experience Interview Form	New
Form 0920-24CB Usability Survey Form	New
Form 0920-24CB Usability Survey Form	New
Form 0920-24CB Post-exposure survey Form	New
Form 0920-24CB Post-exposure survey Form	New
Attachment 13_Approved Privacy Narrative.pdf Supplementary Document	2024-08-05
Attachment 13_Approved Privacy Narrative.pdf Supplementary Document	2024-08-05
4_Prostate Cancer_SSB.docx Supporting Statement B	2024-08-05
4_Prostate Cancer_SSB.docx Supporting Statement B	2024-08-05
Attachment 14_Institutional Review Board Approval.docx Supplementary Document	2024-08-02
Attachment 14_Institutional Review Board Approval.docx Supplementary Document	2024-08-02
Attachment 03_Evaluation Questions and Indicators.docx Supplementary Document	2024-08-02
Attachment 03_Evaluation Questions and Indicators.docx Supplementary Document	2024-08-02
Attachment 02_Study Design Graphic.pdf Supplementary Document	2024-08-02
Attachment 02_Study Design Graphic.pdf Supplementary Document	2024-08-02
Attachment 01_Authorizing Legislation.pdf Supplementary Document	2024-08-02
Attachment 01_Authorizing Legislation.pdf Supplementary Document	2024-08-02
_List of Attachments_SSA & SSB.docx Supplementary Document	2024-08-02
_List of Attachments_SSA & SSB.docx Supplementary Document	2024-08-02
3_Prostate Cancer_SSA.docx Supporting Statement A	2024-08-02
3_Prostate Cancer_SSA.docx Supporting Statement A	2024-08-02

IC Document Collections

IC ID	Document Title	Status
269819	Pre-exposure Survey Form	New
269819	Pre-exposure Survey Form	New
269818	Patient Eligibility Screener Form	New
269818	Patient Eligibility Screener Form	New
269817	Provider Survey Form	New
269817	Provider Survey Form	New
269807	Clinic Coordinator Interview Form	New
269807	Clinic Coordinator Interview Form	New
269805	Post-clinic Survey Form	New
269805	Post-clinic Survey Form	New
269803	User Experience Interview Form	New
269803	User Experience Interview Form	New
269802	Usability Survey Form	New
269802	Usability Survey Form	New
269801	Post-exposure survey Form	New
269801	Post-exposure survey Form	New

ICR Details

Status	Active
Agency/Subagency	HHS/CDC
OMB Control No	0920-1438
Type of Information Collection	New collection (Request for a new OMB Control Number)
Agency Tracking No	0920-24CB
Date Submitted to OIRA	2024-08-06
Requested Expiration Date	1969-12-31