Clearance Checklist

Check list for CDC/ATSDR GenIC clearance

Generic collection title and OMB number: 0920-1027

GenIC title: Telephone Interviews to Screen Potential Focus Group Participants for Exploratory Research and Message Pre-Testing Among Baby Boomers

(DVH)

Generic Collection	GenIC
Statistical methods approved for the generic collection [ ] Yes [ X ] No Specify Sampling Method Sampling Size Type of Analysis used in the background Provide other parameters for the generic clearance including specifics about respondent universe, information collection methods, incentives, PII, plans for reporting or publication, additional scope limitations.	Statistical Methods Provide the methods proposed for the genIC including recruitment or sampling methods Gifts or Payments - the terms compensation, gift, and payment should not be used in the request Will an incentive be offered to respondents? [ ] Yes [ X ] No If yes, how much? Why necessary? Justification must be included in supporting statement A Human Subjects Is IRB approval needed?       [ ] Yes [X ] No    The study protocol can replace sup statement B. A one-pager can be used to explain what is in the protocol.  Plans for Publication and Reporting Will this information be publically disseminated? [ ] Yes [ X ] No If yes, how? Will results be published in a Journal? [ ] Yes [ X ] No For electronic collections, are screenshots included? [ ] Yes [ ] No Are all language versions of documents included? [X ] Yes [ ] No GenICs cannot include assurances of confidentiality (except NCHS) – does this GenIC involve an assurance of confidentiality? [ ] Yes [ X ] No Have other materials (Reminders, e-mails, brochures, etc.) been included? [ X ] Yes [ ] No Final versions of all documents are required because GenICs cannot be amended after submission to HHS/OMB