005-55-AmSamoa Burden Memo

CDC DOCUMENTATION FOR THE GENERIC CLEARANCE

OF EMERGENCY EPIDEMIC INVESTIGATION DATA COLLECTIONS (0920-1011)

GenIC No.:	2014005-055
EPI AID No. (if applicable):	Epi-aid: 2014-055
Requesting entity (e.g., jurisdiction)	American Samoa
Title of Investigation:	Outbreak of diarrheal disease of unknown etiology - American Samoa, May 2014
Purpose of Investigation: (Use as much space as necessary)	To investigate an ongoing outbreak of diarrheal illness in American Samoa to determine the etiology and source of the outbreak so that prevention and control measures can be implemented.
Duration of Data Collection
Date Began:	May 30, 2014
Date Ended:	June 18, 2014
Lead Investigator
Name:	Jennifer Cope
CIO/Division/Branch:	NCEZID/DFWED/WDPB
E-mail Address:	[email protected]
Telephone No.:	(404)718-4878
Mail Stop:	C-09

Complete the following for each instrument used during the investigation.

Data Collection Instrument 1: Gastroenteritis_Hypothesis Generating Questionnaire

Name of Data Collection Instrument: Outbreak of Diarrheal Illness in American Samoa: Hypothesis Generating Questionnaire for Gastroenteritis Complaints

Type of Respondent

[ ] General Public

[ ] Healthcare staff

[ ] Laboratory staff

[X] Patients

[ ] Restaurant staff

[ ] Other: [describe]

Data Collection Methods (check all that apply)

[X] Epidemiologic Study (indicate which type(s) below)

[X] Descriptive Study (describe): Patients with diarrhea were interviewed to generate hypotheses about potential modes of transmission.

[ ] Cross-sectional Study (describe):

[ ] Cohort Study (describe):

[ ] Case-Control Study (describe):

[ ] Other (describe):

[ ] Environmental Assessment (describe):

[ ] Laboratory Testing (describe): stool, blood (serum)

[ ] Other (describe):

Data Collection Mode (check all that apply)

[X] Survey Mode (indicate which mode(s) below):

[X] Face-to-face Interview (describe): Interviews were conducted in Samoan by Department of Health staff with a CDC team member present for 9/11 interviews. Two of 11 interviews were conducted in English.

[ ] Telephone Interview (describe):

[ ] Self-administered Paper-and-Pencil Questionnaire (describe):

[ ] Self-administered Internet Questionnaire (describe):

[ ] Other (describe):

[ ] Medical Record Abstraction (describe):

[ ] Biological Specimen Sample

[ ] Environmental Sample

[ ] Other (describe):

Response Rate (if applicable)

Total No. Responded (A):	11
Total No. Sampled/Eligible to Respond (B):	35
Response Rate (A/B):	31%

Complete the following burden table. Each data collection instrument should be included as a separate row.

Burden Table (insert rows for additional respondent types if needed)

Data Collection Instrument Name	Type of Respondent	No. Respondents (A)	No. Responses per Respondent (B)	Burden per Response in Minutes (C)	Total Burden (in minutes; A x B x C)
Gastroenteritis_Hypothesis Generating Questionnaire	Patients	11	1	45	495

Return completed form and a blank copy of each final data collection instrument within 5 business days of data collection completion to the EEI Information Collection Request Liaison, Danice Eaton ([email protected]).

EI Information Collection Request Liaison:

Danice Eaton, PhD, MPH

EIS Program Staff Epidemiologist

Epidemiology Workforce Branch

Division of Scientific Education and Professional Development

Centers for Disease Control and Prevention

2400 Century Center, MS E-92

Office: 404.498.6389
[email protected]