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: AFIX Quarterly Call Evaluation

PURPOSE:

AFIX (Assessment, Feedback, Information and eXchange) is a quality improvement program designed for use by vaccination providers to increase vaccination coverage levels and supported by CDC’s Immunization Services Division. These are independent AFIX team-led calls held quarterly and the objective of these calls is to provide AFIX program updates, announce the release of new documents and resources, and provide additional technical assistance. The AFIX team would like to assess the satisfaction with the AFIX Quarterly Calls using a brief survey.

The feedback provided by participants in this survey will help the AFIX team assess the success of the calls and plan for future calls. The data collection instrument (Attachment 1) is brief and consists of mostly closed-ended questions. The data collected will not contain personally identifiable information and will not be published. The AFIX team will send an email to participate in the survey and a reminder email to complete the survey once week later.

DESCRIPTION OF RESPONDENTS:

Call participants, which consist mostly of immunization awardee staff, will be the audience of this evaluation survey. Each of the 50 states and 6 US city awardee programs are funded by CDC to prevent and control vaccine-preventable diseases and improving immunization coverage in their jurisdictions.

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: Hanan Awwad (wgn5)

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
State, local, or tribal governments	100	8/60	13 hours
Totals	100	8/60	13 hours

FEDERAL COST: The estimated annual cost to the Federal government is $0

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 universe of the potential respondents is all AFIX Quarterly call participants. Call participants have been identified through the list of AFIX Coordinators. All call participants will be contacted via email and asked to voluntarily participate in the survey.

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

Attachment 1 – AFIX Quarterly Call Evaluation Survey

Attachment 2 - AFIX Quarterly Call participants participation email

Attachment 3 - AFIX Quarterly Call participants follow up email

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