Form 0920-0212 Recruitment Survey Presentation 2019

Attachment I: Recruitment Survey Presentation Form Approved

OMB No. 0920-0212

Exp. date XX/XX/20XX

Notice - CDC estimates the average public reporting burden for this collection of information as 1 hour per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0212).

Assurance of confidentiality-We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA, Title 5 of Public Law 107-347). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you.

National Hospital Care Survey Presentation

For Hospital Executive and Staff

Once a hospital has been identified and selected for the National Hospital Care Survey (NHCS), the contractor will send a letter to the point of contact (POC) at the hospital (e.g., the CEO) from Charlie Rothwell, Director, NCHS. A time will be arranged to have a telephone meeting with the POC and other relevant hospital staff. The goal is to begin the actual induction at that time, but it is understood that some hospitals may require an in-person visit to discuss the project further.

The purpose of this presentation is to talk to hospital staff about participating in the NHCS and encourage them to participate. Information such as the following will be distributed:

• NHCS folder containing a description of NCHS

• Overview Flyer

• NCHS ERB Approval Letter

• Initial Intake Questionnaire

The contractor will describe the purpose of the NHCS and the data to be collected. Additionally, the presentation explains that NHCS data are publicly available for researchers in federal and state governments, hospitals, academia, and other institutions; the public use files do not allow identification of hospitals or patients; and they are used for public health and to inform health care policy and research.

Issues concerning confidentiality will be discussed such as: Health Insurance Portability and Accountability Act (HIPAA), the NCHS ERB, and the Public Health Service Act.