Request for Approval

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1026)

TITLE OF INFORMATION COLLECTION: Feedback on Consumer Access to Immunization Information System (IIS) 0920-1026

PURPOSE:

Each state maintains an immunization information system (IIS), that providers and hospitals report data to regarding the immunizations they have administered to their patients. On April 15, 2014, five states: Alaska, Arizona, Louisiana, Washington, and West Virginia launched a portal that provides patients and parents/legal guardians with online, secure access to the state’s IIS. This access allows patients and parents/guardians to view their or their child’s immunization history, and helps them manage their schedules and coordinate future recommended immunizations with their health provider based on forecasting information, which is also shown as part of the immunization record. Giving parents and patients access to their immunization records promotes public acceptance of recommended vaccinations by engaging the public in the management of their own health and providing them with information about when their physician recommends needed vaccine doses via forecasting. Use of IIS to support patient reminder systems and to determine patient vaccination status is recommended by the Task Force on Community Preventive Services as an evidence-based strategy to increase vaccine uptake.

This data collection effort serves to assess the ease of use of the online portal. The data collection will also assess the penetration of our print marketing materials and how helpful the materials were with making the decision to register for the online portal. The respondent pool includes individuals who have voluntarily registered for the Consumer Access Portal and reside in one of the five participating states (Alaska, Arizona, Louisiana, Washington, and West Virginia). Because there are associated web development costs when using surveygizmo.com, screen shots are currently unavailable until the approval of the data collection. Additionally, this web tool  is more sophisticated that than free webtools because it allows for easier programming of the survey logic for skip patterns and it allows us to display images of our print and online materials which is needed for several questions of the survey. The Consumer Access to Immunization Information System (IIS) Survey will help the program better understand how consumers heard about the portal, which functions of the portal they are using, and which promotional materials were preferred. Initial findings will be summarized for CDC and the participating state immunization programs that are directly affected and funded by the CDC service. Any reference to this data will be reinforced by the understanding that the information gathered yields qualitative information and that the collections are not designed or expected to yield statistically reliable results.  Additionally, they will not be used as though the results are generalizable to the population of study.

DESCRIPTION OF RESPONDENTS: Individuals residing in one of the five participating states (Alaska, Arizona, Louisiana, Washington, and West Virginia) who have voluntarily registered for the Consumer Access Portal.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [x] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [] Other: _

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Shannon Stokley (zma2)

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [ x] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [ x ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals	1650	10 minutes	275 hours
Totals	1650	10 minutes	275 hours

FEDERAL COST: The estimated annual cost to the Federal government is $1125.00.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe?

[x ] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

The Consumer Survey (Feedback on Consumer Access to Immunization Information System (IIS)) will be administered to individuals who have voluntarily registered for the online portal. The survey will be administered approximately 2 weeks after registration was completed. Registration will occur throughout the implementation period (through September 30, 2015), so a complete list of registrants is unavailable at this time. However, as individuals register for the portal, their email address will be used to disseminate an invitation to participate in the online survey. Individuals will receive an email invitation to complete the online survey (survey link will be included). Following standard internet survey guidelines, a reminder email will be sent every 3^rd day (a maximum of 3 reminders will be sent) to individuals who have not completed a survey. If an individual does not complete the survey after receiving the final reminder email, we will assume that the individual has declined to participate in the survey. The response rate is expected to be low (~10%), therefore, we will send a survey to each individual that completed registration.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[x] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [ x ] No

List of attachments:

Attachment A- Consumer Access to Immunization Information System (IIS) Survey

Attachment B- Email Invitation

Attachment C- Email Follow-Up

Attachment D- Print Image_Consumer Brochure

Attachment E- Print Image_Consumer FAQ

Attachment F- Print Image_Security

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