Completed checklist for submissions under 0920-1027

Service Delivery Checklist_Customer Satisfaction Site Visit.docx

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCHHSTP)

Completed checklist for submissions under 0920-1027

OMB: 0920-1027

Document [docx]
Download: docx | pdf

Check list for CDC/ATSDR GenIC clearance


Generic collection title and OMB number: 0920-1027

GenIC title: – Customer Service Satisfaction Assessment of TB Laboratory Site Visits conducted by CDC Laboratory Consultants – Online Survey



Generic Collection

GenIC


Statistical methods approved for the generic collection

[ ] Yes

[ X ] No


Specify

  • Sampling Method

  • Sampling Size

  • Type of Analysis used in the background



Statistical Methods

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?

[] Yes

[ X ] No

  • If yes, how? Data may be published in scientific and public health journals, presented at scientific meetings, and shared with USPHS leadership.


Will results be published in a Journal?

[ ] Yes

[ ] No


For electronic collections, are screenshots included?

[X ] Yes

[ ] No


Are all language versions of documents included?

[X] Yes English Only

[ ] 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?

[ ] Yes

[ X ] No



Final versions of all documents are required because GenICs cannot be amended after submission to HHS/OMB





File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCDC User
File Modified0000-00-00
File Created2021-01-14

© 2024 OMB.report | Privacy Policy