Request for Approval

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1050)

TITLE OF INFORMATION COLLECTION: Soliciting Feedback on National Snapshot of Public Health Preparedness

PURPOSE:

The Office of Public Health Preparedness and Response (OPHPR)/Office of Policy, Planning and Evaluation (OPPE) prepares and disseminates an annual preparedness report called the National Snapshot of Public Health Preparedness ( http://www.cdc.gov/phpr/pubs-links/2015/documents/2015_Preparedness_Report.pdf ), to the Public Health Emergency Preparedness (PHEP) cooperative agreement awardees, Congress, partners, and the general public.

This report describes how CDC and its partners work together to improve our nation’s health security. It also demonstrates Public Health Emergency Preparedness (PHEP) awardees’ progress in preparing for major responses.

OPPE plans to collect information from PHEP awardees on the 2015 National Snapshot of Public Health Preparedness Report’s accessibility, usability and processes that relate to the PHEP awardees. OPPE wants to ensure that the annual preparedness report meets the PHEP Directors’ needs, such as serving as a resource for their state legislative activities. Feedback gathered through this information collection will be used to improve both the report itself and the processes used to write the report.

DESCRIPTION OF RESPONDENTS: Respondents are Directors from the 62 jurisdictions awarded PHEP cooperative agreement funds.

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: Holly Williams________________________________________________

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
PHEP Directors	62	10/60	10
Totals	62	10/60	10

FEDERAL COST: The estimated annual cost to the Federal government is $579.90.

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? [ ] Yes [x] 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?

Respondents are selected as being the main points of contact for the PHEP cooperative agreement.

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

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