Dengue_AZ_Burden

From: Eaton, Danice (CDC/OPHSS/CSELS)
Sent: Friday, December 12, 2014 3:02 PM
To: [email protected]; [email protected]; Richardson, Tony (CDC/OD/OADS); OMB Clearance (CDC)
Cc: Kaufmann, Rachel (CDC/OPHSS/CSELS); Glynn, Kate (CDC/OPHSS/CSELS); Stover, Beth (CDC/OPHSS/CSELS); Wright, Jennifer G. (CDC/OPHSS/CSELS); Bisgard, Kris (CDC/OPHSS/CSELS); Stover, Beth (CDC/OPHSS/CSELS); Neri, Antonio (CDC/OPHSS/CSELS); Bosch, Stacey A. (CDC/OID/NCEZID)
Subject: 0920-1011 GenIC Request: 2015003-XXX Dengue_AZ
Importance: High

Attached is a GenIC request for 0920-1011, Emergency Epidemic Investigations Generic ICR. 

Title (short): Dengue_AZ

External Entity Requesting CDC Assistance: Ken Komatsu, State Epidemiologist, Arizona Department of Health Services

Approval Requested By: November 15, 2014 at 3:00PM

Direct Questions To: Due to shared on-call coverage this weekend, please direct questions to BOTH Kris Bisgard ([email protected]) and Tony Neri ([email protected])

We are direct routing this request to OMB via e-mail to initiate the 72-HOUR approval period. We understand this request also will be entered into ROCIS for official routing. 

The burden estimate for ROCIS is:

Data Collection Instrument Name	Type of Respondent	Data Collection Mode	No. Respondents (A)	No. Responses per Respondent (B)	Burden per Response in Minutes (C)	Total Burden in Hours (A x B x C)/60*
Appendix 1. Household questionnaire	Public	In-person interview	30	1	15	8
Appendix 2. Individual questionnaire	Public	In-person interview	150	1	15	38
Appendix 3. Environmental Collection	Federal and state staff	Field investigation	30	1	15	8
Appendix 4. Dengue case investigation form	Medical record staff	Chart abstraction	10	1	15	2

ATTACHMENTS:

Completed GenIC Form

Data Collection Instruments (Appendices 1-4)

Letter of Invitation