GenIC Request Template - 0920-1050

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

TITLE OF INFORMATION COLLECTION: Partner Feedback Assessment Of Sexually Transmitted Disease (STD) Clinic Processes For Conducting And Documenting Routine HIV Testing

PURPOSE: To obtain feedback during site visits by CDC staff to STD clinics participating in the STD Surveillance Network (SSuN). Stakeholders consist of clinic providers, clinic managers, and data mangers at publicly-funded STD clinics participating in SSuN, who are supported, in part, by the CDC STD SSuN Cycle III Cooperative Agreement. This feedback will provide timely and useful information which will allow CDC staff to better understand clinic processes and may assist CDC staff in supporting SSuN sites and guide changes to CDC’s monitoring of program outcomes. CDC staff will be able to suggest useful recommendations for providing HIV testing and documenting HIV testing and pre-exposure prophylaxis (PrEP) implementation in clinic data systems.

An interview guide was developed and will be administered during in-person interviews with STD clinic staff. The interview guides for clinic providers and clinic and data managers consist of 18-23 open-ended questions (appendices 1 & 2). Clinic staff (i.e., providers, clinic/data managers) will be interviewed by CDC personnel regarding provider perceptions of clinic HIV testing protocols and practices for provision and documentation of HIV testing and documentation of pre-exposure prophylaxis (PrEP) implementation.

Data will be analyzed by CDC project officer and/or CDC project team members and discussed internally within the Division of STD Prevention (DSTDP) and the SSuN.

DESCRIPTION OF RESPONDENTS: DSTDP administers the STD SSuN Cycle III cooperative agreement which funds a network of 29 publicly-funded sentinel STD clinics that are affiliated with state and city health departments in 10 jurisdictions across the United States.

CDC will conduct the partner feedback interviews with clinic providers and clinic/data managers at STD clinics participating in SSuN, who are supported, in part, by the CDC STD SSuN Cycle III Cooperative Agreement. However, DSTDP staff will only conduct the interviews at a selection of approximately five STD clinics participating in SSuN per year. Therefore, annual burden calculations are based on 25 respondents completing the interviews (approximately 5 respondents per site; 3 providers, 2 clinic/data managers).

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software) [ ] Small Discussion Group

[ ] Focus Group [X] Other: Interviews

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: Brandy L. Maddox userID: FTN6

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 (Hours)	Burden (Hours)
SSuN STD Clinics-Provider	15	1	15
SSuN STD Clinics-Manager	10	1	10
Totals	25	1	25

FEDERAL COST: The estimated annual cost to the Federal government is: $35,269.44.

This estimate is based on the number of hours for instrument development, OMB package preparation, data collection, data coding and entry, data analysis, and report preparation by two Health Scientists (GS 13; GS 14).

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? [ X] Yes [ ] 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?

The respondent universe includes all 29 publicly-funded sentinel STD clinics that are affiliated with state and city health departments in 10 jurisdictions across the United States who are supported, in part, by the CDC STD SSuN Cycle III Cooperative Agreement.

DSTDP staff will conduct purposive sampling of relevant staff (i.e., clinic providers, clinic and data managers), in consultation with 5 participating STD clinics annually. DSTDP staff will obtain a clinic staff list with roles/titles and invite selected staff for interview, based on availability during the CDC site visit to conduct interviews.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[X] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ X ] Yes [ ] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

3