genIC Checklist

Check list for CDC/ATSDR GenIC clearance

Generic collection title and OMB number: 0920-1050

GenIC title: Tuberculosis (TB) Training and Education Needs Assessment of the U.S.-affiliated Pacific Islands and Hawaii

Generic Collection	GenIC
Statistical methods approved for the generic collection – N/A [ ] Yes [ ] No Specify Sampling Method Sampling Size Type of Analysis used in the background Provide other parameters for the generic clearance including specifics about respondent universe, information collection methods, incentives, PII, plans for reporting or publication, additional scope limitations.	Statistical Methods – N/A Provide the methods proposed for the genIC including recruitment or sampling methods Gifts or Payments - the terms compensation, gift, and payment should not be used in the request Will an incentive be offered to respondents? [ ] Yes [X ] No If yes, how much? Why necessary? Justification must be included in supporting statement A Human Subjects Is IRB approval needed?       [ ] Yes [X] No    The study protocol can replace sup statement B. A one-pager can be used to explain what is in the protocol.  Plans for Publication and Reporting Will this information be publically disseminated? [X ] Yes [ ] No If yes, how? Information may be presented at relevant TB conferences (e.g., the 2017 Pacific Islands TB Controllers Association Conference). Will results be published in a Journal? [ ] Yes [X] No For electronic collections, are screenshots included? [ X ] Yes [ ] No Are all language versions of documents included? [X] Yes [ ] No GenICs cannot include assurances of confidentiality (except NCHS) – does this GenIC involve an assurance of confidentiality? [ ] Yes [X] No Have other materials (Reminders, e-mails, brochures, etc.) been included? [X] Yes [ ] No Final versions of all documents are required because GenICs cannot be amended after submission to HHS/OMB