Non-substantial Change Request to OMB Control # 0920-1011
Emergency Epidemic Investigation Data Collections
Year 1,
Quarter 3 (Date Submitted: March 2, 2015)
This
is a non-substantive change request for the Emergency Epidemic
Investigations (EEI) Generic ICR, (OMB Control No. 0920-1011,
Expiration 3/31/17). This allows the Centers for Disease Control and
Prevention (CDC) to continue to conduct EEIs in response to acute
public health emergencies resulting from outbreaks or events with
undetermined agents, undetermined sources, undetermined modes of
transmission or undetermined risk factors. CDC frequently is called
upon to conduct EEIs at the request of one or more external partners
(e.g., local, state, tribal, military, port, other federal agency, or
international health authorities or other partner organizations)
seeking support to respond to urgent public health problems. In
response to external partner requests, CDC readily provides necessary
epidemiologic support to facilitate appropriate engagement in
epidemiological investigations. Such investigations often are
dependent on rapid and flexible data collection that evolves during
the investigation period.
This non-substantive change
request is submitted to comply with the stated procedures in the
approved EEI Generic ICR package (as specified in point 5 under
Special Circumstances Relating to the Guidelines of 5 CFR 1320.5),
“CDC maintains a library of data collection instruments that
includes all final data collection instruments conducted under this
generic ICR. This library and the updated burden numbers based on
data collected via the “Burden Memo” are submitted to OMB
quarterly as a non-substantive change to the generic ICR.”
This non-substantive change request includes the following: Burden
Memos (Appendix 1) and final data collection forms (Appendix 2) for
the 12 investigations conducted under 0920-1011 for which data
collection was completed during Y1Q3 (October 1, 2014 to December 31,
2014).
The actual
burden for the 12 investigations completed during Y1Q3 was 14,866
respondents and 4,916 burden hours. This is greater than the 8,585
respondents and 1,972 burden hours that was projected in the GenIC
requests for these investigations.
Table
1. Burden in Y1Q3
Type of Respondents |
Form Name |
No. of Respondents |
Avg. Burden per Response (in hrs.) |
Total Burden (in hrs.) |
Emergency Epidemic Investigation Participants |
Emergency Epidemic Investigation Data Collection Instruments |
14,866 |
20/60 |
4,916 |
Total |
4,916 |
Table 2 below summarizes the data collection form name and projected and actual burden for each approved GenIC. A projected burden of 0 indicates the data collection form was developed in the field.
Table 2. Y1Q3 Data Collection Forms and Projected and Actual Burden, By GenIC
|
|
|
Projected Burden |
Actual Burden |
||||||||
GenIC No. (OMB) |
Date Approved |
Form Name |
No. Respondents |
Hours |
No. Respondents |
Hours |
||||||
2014009-XXX |
7/7/2014 |
Chikungunya_Questionnaire |
147 |
172 |
106 |
36 |
||||||
2014009-XXX |
7/7/2014 |
Chikungunya_Consent-Parental Permission Form |
147 |
13 |
102 |
9 |
||||||
2014011-XXX |
7/8/2014 |
Ebola_Case Investigation Form |
600 |
250 |
4000 |
1667 |
||||||
2014011-XXX |
7/8/2014 |
Ebola_Contract Tracing Form |
2000 |
100 |
1500 |
75 |
||||||
2014011-XXX |
7/8/2014 |
Ebola_KAP_HCW |
0 |
0 |
40 |
20 |
||||||
2014011-XXX |
7/8/2014 |
Ebola_KAP_Public |
0 |
0 |
360 |
60 |
||||||
2014011-XXX |
7/8/2014 |
Ebola_KAP_County Health Director |
0 |
0 |
6 |
6 |
||||||
2014013-XXX |
7/16/2014 |
Respiratory Illness_Case Investigation Form |
450 |
225 |
71 |
36 |
||||||
2014013-XXX |
7/16/2014 |
Respiratory Illness_Hospitaized Case Investigation Form |
100 |
50 |
5 |
3 |
||||||
2014013-XXX |
7/16/2014 |
Respiratory Illness_Interview Assent Form |
0 |
0 |
8 |
2 |
||||||
2014013-XXX |
7/16/2014 |
Respiratory Illness_Carriage Assent Form |
0 |
0 |
609 |
51 |
||||||
2014013-XXX |
7/16/2014 |
Respiratory Illness_Infection Control Assessment |
0 |
0 |
1 |
8 |
||||||
2014013-XXX |
7/16/2014 |
Respiratory Illness_Rapid Environmental Health Assessment |
0 |
0 |
1 |
8 |
||||||
2014014-XXX |
7/21/2014 |
Ebola_Case Investigation Form |
600 |
250 |
3600 |
1500 |
||||||
2014014-XXX |
7/21/2014 |
Ebola_Contract Tracing Form |
2000 |
100 |
2000 |
100 |
||||||
2014015-XXX |
8/13/2014 |
Parechovirus_Chart Abstraction Form |
1 |
13 |
4 |
17 |
||||||
2014015-XXX |
8/13/2014 |
Parechovirus_Chart Abstraction Form |
0 |
0 |
2 |
14 |
||||||
2014015-XXX |
8/13/2014 |
Parechovirus_Family Interview Questionnaire |
20 |
5 |
26 |
13 |
||||||
2014015-XXX |
8/13/2014 |
Parechovirus_Patient_Sibling Diaper Collection |
0 |
0 |
26 |
2 |
||||||
2014016-XXX |
9/4/2014 |
Ebola_Case Investigation Form |
200 |
84 |
0 |
0 |
||||||
2014016-XXX |
9/4/2014 |
Ebola_Contract Tracing Form |
1000 |
50 |
0 |
0 |
||||||
2014016-XXX |
9/4/2014 |
Ebola_RECO Interview |
0 |
0 |
18 |
3 |
||||||
2014016-XXX |
9/4/2014 |
Ebola_Health Facility Assessment |
0 |
0 |
5 |
1 |
||||||
2014017-XXX |
9/15/2014 |
Chart Abstraction Form |
4 |
40 |
3 |
72 |
||||||
2014017-XXX |
9/15/2014 |
Reuse and Reprocessing Checklist |
2 |
10 |
6 |
2 |
||||||
2014017-XXX |
9/15/2014 |
Outpatient Dialysis Center Practices Survey |
20 |
35 |
0 |
0 |
||||||
2014018-XXX |
9/22/2014 |
Paralysis_Medical Chart Abstraction Form |
1 |
9 |
1 |
6 |
||||||
2014018-XXX |
9/22/2014 |
Paralysis_Questionnaire for Family Interview |
9 |
3 |
0 |
0 |
||||||
2014019-XXX |
9/24/2014 |
Pseudomonas_Hand Hygiene Audit Tool |
30 |
5 |
0 |
0 |
||||||
2014019-XXX |
9/24/2014 |
Pseudomonas_CLABSI Checklist Tool |
15 |
3 |
0 |
0 |
||||||
2014019-XXX |
9/24/2014 |
Pseudomonas_Chart Abstraction Form |
45 |
23 |
1 |
1 |
||||||
2014019-XXX |
9/24/2014 |
Pseudomonas_Healthcare Personnel Interview Tool |
70 |
12 |
0 |
0 |
||||||
2014019-XXX |
9/24/2014 |
Pseudomonas_Health Care Practices Audit Forms |
0 |
0 |
1 |
2 |
||||||
2014020-XXX |
10/2/2014 |
Ebola_Burial Practices Field Guide |
33 |
25 |
0 |
0 |
||||||
2014020-XXX |
10/2/2014 |
Ebola_Burial Practices Observation Guide |
40 |
40 |
0 |
0 |
||||||
2014020-XXX |
10/2/2014 |
Ebola_Burial Practices Focus Group Guide |
40 |
40 |
373 |
467 |
||||||
2014020-XXX |
10/2/2014 |
Ebola_Health-care Worker Ebola Virus Exposure Risk Report |
0 |
0 |
11 |
6 |
||||||
2014020-XXX |
10/2/2014 |
Ebola_Contact Tracer FGD Topic Guide_Liberia |
0 |
0 |
5 |
5 |
||||||
2014020-XXX |
10/2/2014 |
Ebola_Contact Tracer Supervisor KII Topic Guide_Liberia |
0 |
0 |
2 |
2 |
||||||
2014020-XXX |
10/2/2014 |
Ebola_Community Leader FGD Topic Guide_Liberia |
0 |
0 |
25 |
38 |
||||||
2014020-XXX |
10/2/2014 |
Ebola_Community Member FGD Topic Guide_Liberia |
0 |
0 |
47 |
71 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_Case Investigation Form |
1 |
1 |
0 |
0 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_Case Contact Questionnaire |
75 |
13 |
85 |
22 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_Contact Tracing Form |
0 |
0 |
15 |
12 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_Exposure Assessment Questionnaire for Airline Passengers |
0 |
0 |
92 |
31 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_Bridal Store Visitor Questionnaire |
0 |
0 |
56 |
5 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_Daily Contact Symptom Follow-up Log |
0 |
0 |
20 |
4 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_Daily Contact Symptom Follow-up Log |
0 |
0 |
93 |
8 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_Domestic Animal Questionnaire for Contacts Under Active Monitoring |
0 |
0 |
5 |
1 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_Healthcare Workers Interview Form 10/11/2014 |
0 |
0 |
282 |
24 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_Healthcare Worker Supplemental Interview Form |
0 |
0 |
282 |
24 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_21-day fever and symptom follow-up form |
0 |
0 |
179 |
15 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_Contact Questionnaire REVISED |
0 |
0 |
6 |
2 |
||||||
2014022-XXX |
10/2/2014 |
Ebola_Case Contact Questionnaire |
0 |
0 |
45 |
12 |
||||||
2015001-XXX |
10/3/2014 |
CCHF_Case Investigation Questionnaire |
30 |
3 |
1 |
2 |
||||||
2015001-XXX |
10/3/2014 |
CCHF_KAP Survey |
400 |
200 |
651 |
326 |
||||||
2015001-XXX |
10/3/2014 |
CCHF_Consent Form |
400 |
100 |
0 |
0 |
||||||
2015002-XXX |
11/6/2014 |
Suicide_Administrator and Counselor Interview Guide |
30 |
23 |
18 |
18 |
||||||
2015002-XXX |
11/6/2014 |
Suicide_Parent Focus Group Guide |
75 |
75 |
71 |
107 |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Tony Richardson |
File Modified | 0000-00-00 |
File Created | 2021-01-24 |