Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCHHSTP)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Appendix 2_Web Shots_Survey Questions_Site Visit Evaluation_Six Month Follow-up	Form	New	Available
Appendix 1_Survey Questions_Site Visit Evaluation_ Six month Follow-up	Form	New	Available
US PHS PPAC Survey on Access to Health Care	Form and Instruction	New	Available
TB Labs Site Visit Assessment	Form	New	Available
TB Lab Site Visit Assessment	Form	New	Available
National PHL DST Reference Center for MTBC Survey	Form and Instruction	New	Available
Sscreener	Form and Instruction	New	Available
Consent and Interview Guide	Form and Instruction	New	Available
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP) Usability Study	Form and Instruction	New	Available
Facilitator Script Interview	Form and Instruction	New	Available
Act Against AIDS Online Survey (Screenshots)	Form and Instruction	New	Available
Act Against AIDS In-Person Survey	Form and Instruction	New	Available
Stakeholder Analysis Adolescent Online Survey	Form and Instruction	New	Available
Stakeholder Analysis MSM Online Survey	Form and Instruction	New	Available
Screener	Form	New	Available
Form N one Focus Groups for Exploratory Research and Message Pre-Testing Among Foreign-Born Asian Americans	Form and Instruction	New	Available
Moderator's guide	Form and Instruction	New	Available
Recruitment screener	Form and Instruction	New	Available
Division of STD Prevention Twitter Survey	Form	New	Available
Generic Clearance for Qualitative Feedback Template Approval Form.docx	Supplementary Document	Uploaded 2014-07-03	Available
Supporting_Statement_B-NCHHSTP FastTrack .docx	Supporting Statement B	Uploaded 2014-07-03	Available
Supporting_Statement_A-NCHHSTP FastTrack.docx	Supporting Statement A	Uploaded 2014-07-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
226173	TB Laboratory Site Visit Evaluation Six-Month Follow-Up-Online Survey	Form	New	Appendix 2_Web Shots_Survey Questions_Site Visit Evaluation_Six Month Follow-up
226173	TB Laboratory Site Visit Evaluation Six-Month Follow-Up-Online Survey	Form	New	Appendix 1_Survey Questions_Site Visit Evaluation_ Six month Follow-up
225702	US Public Health Service (USPHS) Medical Officer Healthcare Access Survey	Form and Instruction	New	US PHS PPAC Survey on Access to Health Care
225689	Customer Satisfaction Assessment of CDC TB Lab Site Visits	Form	New	TB Labs Site Visit Assessment
225689	Customer Satisfaction Assessment of CDC TB Lab Site Visits	Form	New	TB Lab Site Visit Assessment
224646	TB DST Reference Center for MTBC Assessment – Online Survey	Form and Instruction	New	National PHL DST Reference Center for MTBC Survey
221086	Study to Inform HIV Screening and PrEP Resources for Health Care Providers	Form and Instruction	New	Sscreener
221086	Study to Inform HIV Screening and PrEP Resources for Health Care Providers	Form and Instruction	New	Consent and Interview Guide
220867	National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP) Usability Study	Form and Instruction	New	National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP) Usability Study
220844	Take Charge of Your Sexual Health: What you need to know about preventive services: Pre-Testing Hispanic Community	Other-WORD	New
219568	User Insights for NCHHSTP Atlas Website and Tool Review _Online Survey	Other-Screenshots	New
219430	User Insights for NCHHSTP Atlas Website and Tool Review- Interviews	Form and Instruction	New	Facilitator Script Interview
218898	Baseline Usability Testing for DHAP's Act Against AIDS Website- Online Survey	Form and Instruction	New	Act Against AIDS Online Survey (Screenshots)
218898	Baseline Usability Testing for DHAP's Act Against AIDS Website- Online Survey	Form and Instruction	New	Act Against AIDS In-Person Survey
217781	Post-Launch Usability Testing for the CDC HIV Website Redesign (On-line)	Other-WORD	New
217631	MSM AYA Stakeholder Analysis Survey	Form and Instruction	New	Stakeholder Analysis Adolescent Online Survey
217631	MSM AYA Stakeholder Analysis Survey	Form and Instruction	New	Stakeholder Analysis MSM Online Survey
216077	Research and Message Pre-testing among Baby Boomers - Hepatitis C	Form	New	Screener
216077	Research and Message Pre-testing among Baby Boomers - Hepatitis C	Instruction	New
215629	Focus Groups for Exploratory Research and Message Pre-Testing Among Foreign-Born Asian Americans	Form and Instruction	New	Focus Groups for Exploratory Research and Message Pre-Testing Among Foreign-Born Asian Americans
215178	Telephone Interviews to Screen Potential Focus Group Participants for Exploratory Research and Message Pre-Testing Among Foreign-Born Asian Americans	Instruction	New
214752	Provider Feedback for Chlamydia Prevention and Control Online Resources	Form and Instruction	New	Moderator's guide
214752	Provider Feedback for Chlamydia Prevention and Control Online Resources	Instruction	New
214752	Provider Feedback for Chlamydia Prevention and Control Online Resources	Form and Instruction	New	Recruitment screener
212811	CDC Division of STD Prevention Twitter Evaluation	Form	New	Division of STD Prevention Twitter Survey

ICR Details

OMB Control No: 0920-1027	ICR Reference No: 201407-0920-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 14AMW
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCHHSTP)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/05/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/14/2014
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2017	36 Months From Approved
Responses	56,850	0	0
Time Burden (Hours)	37,200	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 24432	04/30/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 39402	07/10/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 17

table that charts list of burden

IC Title	Form No.	Form Name
Post-Launch Usability Testing for the CDC HIV Website Redesign (On-line)
Baseline Usability Testing for DHAP's Act Against AIDS Website- Online Survey	NA, NA	Act Against AIDS In-Person Survey ,   Act Against AIDS Online Survey (Screenshots)
CDC Division of STD Prevention Twitter Evaluation	None	Division of STD Prevention Twitter Survey
Customer Satisfaction Assessment of CDC TB Lab Site Visits	none, none	TB Lab Site Visit Assessment ,   TB Labs Site Visit Assessment
Focus Groups for Exploratory Research and Message Pre-Testing Among Foreign-Born Asian Americans	N one	Focus Groups for Exploratory Research and Message Pre-Testing Among Foreign-Born Asian Americans
MSM AYA Stakeholder Analysis Survey	NA, NA	Stakeholder Analysis Adolescent Online Survey ,   Stakeholder Analysis MSM Online Survey
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP) Usability Study	NA	National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP) Usability Study
Provider Feedback for Chlamydia Prevention and Control Online Resources	none, none	Recruitment screener ,   Moderator's guide
Research and Message Pre-testing among Baby Boomers - Hepatitis C	none	Screener
Study to Inform HIV Screening and PrEP Resources for Health Care Providers	none, none	Sscreener ,   Consent and Interview Guide
TB DST Reference Center for MTBC Assessment – Online Survey	NA	National PHL DST Reference Center for MTBC Survey
TB Laboratory Site Visit Evaluation Six-Month Follow-Up-Online Survey	N/A, N/A	Appendix 1_Survey Questions_Site Visit Evaluation_ Six month Follow-up ,   Appendix 2_Web Shots_Survey Questions_Site Visit Evaluation_Six Month Follow-up
Take Charge of Your Sexual Health: What you need to know about preventive services: Pre-Testing Hispanic Community
Telephone Interviews to Screen Potential Focus Group Participants for Exploratory Research and Message Pre-Testing Among Foreign-Born Asian Americans
US Public Health Service (USPHS) Medical Officer Healthcare Access Survey	NA	US PHS PPAC Survey on Access to Health Care
User Insights for NCHHSTP Atlas Website and Tool Review _Online Survey
User Insights for NCHHSTP Atlas Website and Tool Review- Interviews	NA	Facilitator Script Interview

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	56,850	0	0	56,850	0	0
Annual Time Burden (Hours)	37,200	0	0	37,200	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $370,500

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/14/2014

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