ISP PM Data Collection

Attachment – A: Program Manager Data Collection Instrument

Form approved

OMB No. 0920-0879

Expiration Date 03/31/2014

ADD DATE HERE

Dear Colleague,

You are being contacted to help us identify Disease Intervention Specialists (DIS) who conduct partner service activities.

In the January 2013 Director’s Update, Dr. Bolan briefly discussed upcoming Division of STD Prevention (DSTDP) activities related to Internet Partner Services (IPS). One of those activities is to conduct an assessment of current IPS activities at the state and local level in order to update the National IPS Guidelines, identify potential best practices, and to establish a technical assistance network. We plan on beginning that effort in the next month, but we need your assistance prior to implementation.

Please provide the following information for each DIS in your program who conduct partner services or notification activities:

Name

Organization (State, County, or City Name)

Phone Number

E Mail address

We recommend that you share this email with DIS prior to submitting their contact information so they have some context when contacted. Participation by DIS in the assessment is voluntary. All information obtained will be kept secure, and results from the assessment will be reported in an aggregate form.

Your assistance in making this assessment a success is greatly appreciated. If you have any questions or concerns, please feel free to contact me.

Sincerely,

Frank Strona

Division of STD Prevention

IPS Coordinator

(415) 355-2016  

[email protected]

Public reporting burden of this collection of information is estimated to average 8 minutes per response, including the time for reviewing the instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Rd, NE, MS D-74, Atlanta, GA 30333; ATTN: PRA (0920-0879).