Change request memo - Y1Q3

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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