Emergency Epidemic Investagation OMB Form

OMB No. 0920-0008

Emergency Epidemic Investigations

1. EPI AID No.:
2. Title of Investigation:

3. Used for the following purpose:

4. Date of Investigation:

2010-024
Surveillance of U.S. Family Planning Providers’
Use of Contraception Guidelines and Practices
Related to Contraceptive Use for Women with
Specific Characteristics or Medical Conditions
The objectives of this investigation included the
following:
1. Among U.S. family planning providers,
estimate the prevalence of key
contraceptive practices, including use of
contraception guidelines.
2. Establish baseline attitudes on the safety
of contraceptive methods for women with
specific characteristics or medical
conditions to measure impact after the
release of the US MEC.
3. Assess differences in practices and
attitudes between public and private family
planning providers.
4. Identify gaps between evidence and
practice to guide development of
educational interventions and provider
tools to improve service delivery.

Beginning: December 7, 2009
End: March 5, 2010

Complete this section for each instrument used during the investigation
Data Collection Method

A. Description of Respondents:
(i.e., individuals, households, physicians,
etc.)
B. Estimated Number of Respondents:

Personal Interview


Telephone
X
Mail


Other (please specify):
Providers of family planning services
1,783

One time only
C. No. of responses per respondent
(i.e., one time only, once a week for 2
weeks).
10 minutes
D. Burden per response (i.e. time to

OMB No. 0920-0008

complete the data collection instrument)
17,830 minutes
Total Annual Burden (multiply B X C X D):

Project Officer:

Name: Crystal P. Tyler
Title: Epidemic Intelligence Service Officer
CIO: ONDIEH
Phone: 770-488-6371