Pia

Save

Privacy Impact Assessment Form
v 1.47.4
Status Draft

Form Number

F-84263

Form Date

Question

Answer

1

OPDIV:

CDC

2

PIA Unique Identifier:

P-3368212-188367

2a Name:

8/2/2016 9:53:27 AM

Q-Video (N/A)
General Support System (GSS)
Major Application

3

Minor Application (stand-alone)

The subject of this PIA is which of the following?

Minor Application (child)
Electronic Information Collection
Unknown

3a

Identify the Enterprise Performance Lifecycle Phase
of the system.

Operations and Maintenance
Yes

3b Is this a FISMA-Reportable system?

4

Does the system include a Website or online
application available to and for the use of the general
public?

5

Identify the operator.

6

Point of Contact (POC):

7

Is this a new or existing system?

8

Does the system have Security Authorization (SA)?

8b Planned Date of Security Authorization

No
Yes
No
Agency
Contractor
POC Title

Behavioral Scientist

POC Name

Kristen Miller

POC Organization CDC\NCHS\ORM
POC Email

[email protected]

POC Phone

301-458-4625
New
Existing
Yes
No
5/3/2010 12:00:00 AM
Not Applicable

Page 1 of 6

Save

9

Indicate the following reason(s) for updating this PIA.
Choose from the following options.

PIA Validation (PIA
Refresh/Annual Review)
Anonymous to NonAnonymous
New Public Access
Internal Flow or Collection

Significant System
Management Change
Alteration in Character of
Data
New Interagency Uses
Conversion

Commercial Sources

10

Describe in further detail any changes to the system
that have occurred since the last PIA.

11 Describe the purpose of the system.

Describe the type of information the system will
collect, maintain (store), or share. (Subsequent
12
questions will identify if this information is PII and ask
about the specific data elements.)
Provide an overview of the system and describe the
13 information it will collect, maintain (store), or share,
either permanently or temporarily.
14 Does the system collect, maintain, use or share PII?

15

Indicate the type of PII that the system will collect or
maintain.

None
Q-Video is a digitized video/audio application that supports
the Questionnaire Design Research Laboratory (QDRL) staff in
their analysis of survey questions for the purpose of reduction
of response error in surveys. The application captures, stores,
and indexes the video and audio of a test interview in a
digitized database for the purpose of searching and analysis by
QDRL researchers.

Information collected and stored are:
Interview locations. dates and times;
Project Name/Description/Scope;
Principal Investigator and Interviewer names;
Q-Video is a digitized video/audio application that supports
the QDRL staff in their analysis of survey questions for the
purpose of reduction of response error in surveys. The
Yes
No
Social Security Number

Date of Birth

Name

Photographic Identifiers

Driver's License Number

Biometric Identifiers

Mother's Maiden Name

Vehicle Identifiers

E-Mail Address

Mailing Address

Phone Numbers

Medical Records Number

Medical Notes

Financial Account Info

Certificates

Legal Documents

Education Records

Device Identifiers

Military Status

Employment Status

Foreign Activities

Passport Number

Taxpayer ID
Gender
Principal Investigator Name and Interviewer name (both of
which are published by CDC in the project’s Final Report)
Race
Meta Notes

Page 2 of 6

Save
Employees
Public Citizens
Business Partners/Contacts (Federal, state, local agencies)

Indicate the categories of individuals about whom PII
16
is collected, maintained or shared.

Vendors/Suppliers/Contractors
Patients
Other

17 How many individuals' PII is in the system?
18 For what primary purpose is the PII used?
19

Describe the secondary uses for which the PII will be
used (e.g. testing, training or research)

Recruited participants for survey question testing and
analysis purposes

500-4,999
The PII is used in the process of testing Pre-Fielded Survey
Questions.
PII may also be used for research purposes.

20 Describe the function of the SSN.

N\A

20a Cite the legal authority to use the SSN.

N\A

21

Identify legal authorities governing information use
Public Health Service Act, Section 306(b) (42 U.S.C. 242k).
and disclosure specific to the system and program.

22

Are records on the system retrieved by one or more
PII data elements?

Yes
No
Directly from an individual about whom the
information pertains
In-Person
Hard Copy: Mail/Fax
Email
Online
Other
Government Sources

23

Within the OPDIV
Other HHS OPDIV
State/Local/Tribal
Foreign
Other Federal Entities
Other

Identify the sources of PII in the system.

Non-Government Sources
Members of the Public
Commercial Data Broker
Public Media/Internet
Private Sector
Other
23a

Identify the OMB information collection approval
number and expiration date.

0920-0222 Exp 07/31/2018

Page 3 of 6

Save
24 Is the PII shared with other organizations?

Describe the process in place to notify individuals
25 that their personal information will be collected. If
no prior notice is given, explain the reason.

Yes
No
All prospective participants in a QDRL test project are formally
recruited and screened by the QDRL Laboratory Manager and
QDRL staff. The entire screening process is scripted with
questions and available choice of answers. If a prospective
participant fits the project criteria, they are asked to take part
in the project/study. They are informed of the location of the
project/study and specifics about the study subject matter and
questions. They are also informed about the nature and steps
of the interview process. They are told the reason for the study.
They are told that their participation in the study and their
answers will help QDRL find out if the survey questions will be
easy for other people to answer. They are informed that
everything they say will be kept private. They are also told that
with their permission, the QDRL staff would like to video
record their interview. They are informed that the video
provides a record of what was asked of them and what their
answers were. They are asked if they give their permission for
QDRL staff to video record their interview. If they answer no
they are asked if they will give permission to audio record their
interview. If they answer no the participant is not included in
the project/study. If they answer yes to having their interview
either the video or audio recorded the actual schedule for their
interview is set.
Participants read and sign the Assurance of Confidentiality and
Informed Consent Form prior to the start of their interview.
There are five alternative attachments to cover the various
consent situations. The form states that participation is
voluntary, they are free to terminate the interview at any time,
and if they do so they will still receive full payment for their
participation. The participant may also be asked to sign the
Special consent for Expanded Use of Video and Audio
Recordings Form. The purpose of this form is to allow for the
playing of videos at conferences, meetings, or in the classroom
to illustrate particular findings from cognitive interviewing.
Participants are provided a copy of the forms signed which
includes contact information for the QDRL Laboratory Manager
and staff, The NCHS ERB Chair, and the NCHS Confidentiality
Officer. At the close of the interview the participant may also
be asked to sign the Special Consent Document to Send Video
and Audio Recordings to Off-site Researchers working on the
project so that they may also view or listen to the recording.

26

Is the submission of PII by individuals voluntary or
mandatory?

Voluntary
Mandatory

Prospective participants are asked if they give their permission
Describe the method for individuals to opt-out of the for QDRL staff to video record their interview. If they answer no
they are asked if they will give permission to audio record their
collection or use of their PII. If there is no option to
27
interview. If they answer no the participant is not included in
object to the information collection, provide a
the project/study. If they answer yes to having their interview
reason.
either the video or audio recorded the actual schedule for their
interview is set.

Page 4 of 6

Save
Describe the process to notify and obtain consent
from the individuals whose PII is in the system when
major changes occur to the system (e.g., disclosure
If major changes are made to the system, the Consent Notice
28 and/or data uses have changed since the notice at
the time of original collection). Alternatively, describe would be modified to advise of those changes.
why they cannot be notified or have their consent
obtained.
Describe the process in place to resolve an
individual's concerns when they believe their PII has
29 been inappropriately obtained, used, or disclosed, or
that the PII is inaccurate. If no process exists, explain
why not.

Individuals should contact the the Division of Health Interview
Statistics within CDC/NCHS. When contacting, they should
reasonably identify the record, specify the information being
contested, and state the corrective active sought, with
supporting information to show how the record is inaccurate,
incomplete, untimely, or irrelevant.
The PII review process is conducted with each project.

Describe the process in place for periodic reviews of
PII contained in the system to ensure the data's
30
integrity, availability, accuracy and relevancy. If no
processes are in place, explain why not.

31

Identify who will have access to the PII in the system
and the reason why they require access.

Not only is PII reviewed, the entire project is reviewed with
each new project. The project owner (requesting Survey or
organization) and QDRL determine the scope of the project,
the targeted demographics, and the questions to be tested,
the number of participants, etc. Each project is then submitted
to OMB and ERB for review and approval to proceed. They
review the entire project, not just the PII, but all aspects of the
project. They may or may not require changes to the project
and they give the final approval to conduct the project
Users

All data needs to be available to factor
into their analysis and write their
reports.

Administrators

Conducts basic system administration
functions, including system backups,
data storage and raid management,
trouble shooting, etc.

Developers

Develops, manages and maintains the
system. As part of maintaining Q-Video
the contractor indexes all video data
and builds the video database for
searching.

Contractors

Contractors perform in a range of
duties and labor categories that
require PII access. They recruit
respondents, conduct interviews,
operate the Lab and record the
interviews as well as provide technical
and programming support.

Others
Describe the procedures in place to determine which Role Based Access Control (RBAC) procedures are used to
ensure that only those individuals having a need to access PII
32 system users (administrators, developers,
in the course of their job roles and responsibilities are given
contractors, etc.) may access PII.
access.
Describe the methods in place to allow those with
33 access to PII to only access the minimum amount of
information necessary to perform their job.

In employing RBAC, the Least Privileged model is utilized to
ensure that those with access to PII can access only the
minimal amount of data required to perform their job duties.

Page 5 of 6

Save
Identify training and awareness provided to
personnel (system owners, managers, operators,
contractors and/or program managers) using the
34
system to make them aware of their responsibilities
for protecting the information being collected and
maintained.

All CDC personnel are required to undergo Security and
Privacy Awareness training on an annual basis.

Describe training system users receive (above and
35 beyond general security and privacy awareness
training).

None

Do contracts include Federal Acquisition Regulation
36 and other appropriate clauses ensuring adherence to
privacy provisions and practices?

Yes
No

Describe the process and guidelines in place with
37 regard to the retention and destruction of PII. Cite
specific records retention schedules.

The governing Records Schedule is N1-442-09-1, item 1 ().
Accordingly, records are retained and disposed of in
accordance with the CDC Records Control Schedule for NCHS
records. Original survey records are reviewed for accuracy,
edited, and data (without personal identifiers such as name or
Social Security number) are transferred to computer files. The
original records are retained in locked office files of NCHS until
the process of conversion to computer tape and verification of
information is completed.

Describe, briefly but with specificity, how the PII will
38 be secured in the system using administrative,
technical, and physical controls.

Video and Audio recordings on the Q-Video system are located
on a secure QDRL internal LAN to which access is limited. The
LAN has no outside connectivity or any connectivity to any
other network or LAN, including the CDC network and the
internet. The Q-Video system is located in a locked area and
access is limited and with secured password entry. All archived
data are stored in a locked room and electronic data is secured
by a password. Data that includes personal information (such
as names and addresses) are also stored in a locked room (not
on, or part of the Q-Video System and separate from the QDRL
Laboratory).

General Comments

OPDIV Senior Official
for Privacy Signature

Beverly E.
Walker -S

Digitally signed by Beverly E. Walker -S
DN: c=US, o=U.S. Government,
ou=HHS, ou=CDC, ou=People,
0.9.2342.19200300.100.1.1=10014403
43, cn=Beverly E. Walker -S
Date: 2016.12.12 18:25:36 -05'00'

Page 6 of 6