Sudden Infant Death and Investigation Report Form

Form approved

OMB # 0920-1158

Exp. date 01/31/2020

CDC I-Catalyst Project 6 – Sudden Unexplained Infant Death Investigation Reporting Form (SUIDIRF) Interview Protocol Guide and Questions

Background Information: In 1996, CDC released the original Sudden Unexplained Infant Death Investigation Reporting Form (SUIDIRF). The form is used to collect information at the scene of an infant death. This information is used by 2 primary groups: 1) the death certifier to better determine cause and manner of death; and 2) child death investigators to discuss infant death prevention strategies. Although the form has gone through several updates, CDC does not know how death certifiers and child death review teams perceive the usability and quality of the form. CDC is preparing to update the form again. CDC would like to know if death scene investigators will use an updated SUIDIRIF form because it improves their workflow.

Interviewer to Respondent: Hi, my name is ...Thank you for your time. I know you are busy, I only need about 30 minutes of your time. I’m from CDC National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) working on a project involving the Sudden Unexplained Infant Death Investigation Reporting Form (SUIDIRF), and want to ask some questions to learn more about your work and process at the scene of an infant death. Thank you for participating in this data collection effort. We will use the opinions and impressions you provide only for analyzing the general trends and directions of strategic planning, implementation, collaboration and partnership development within your respective region and across regions. You will not be identified in any published reporting. Individual respondents will not be identified in study reports except with their express permission. However, you should understand that we cannot promise confidentiality of the information you share with us due to our need to comply with provisions of the Freedom of Information Act and also in the event of unlikely but possible litigation or legal proceedings.

I understand that you are a: Medical examiner/forensic pathologist; law enforcement; death investigator; can you describe your role and procedures at an infant death scene?

1. Tell me about how you conduct a typical infant death investigation.

2. Do you use the Sudden Unexplained Infant Death Investigation Reporting Form (SUIDIRF) form?

3. Which parts of the SUIDIRF form are not completed? And how do you determine which parts to skip or not complete?

4. Do you have an adapted version of the SUIDIRF form?

5. Can you tell me about your process for completing child infant death reports?

6. Are there others that you think we should talk to? Can you connect us

Thank you for your time.

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1158).