GenIC Request

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB Control Number: XXXX-YYYY)
Instruction: This form should be completed by the primary contact person from the Program sponsoring
the collection.
DETERMINE IF YOUR COLLECTION IS APPROPRIATE FOR THIS GENERIC
CLEARANCE MECHANISM:
Instruction: Before completing and submitting this form, determine first if the proposed collection is
consistent with the scope of the Collection of Routine Customer Feedback generic clearance mechanism.
To determine the appropriateness of using the Collection of Routine Customer Feedback generic
clearance mechanism, complete the checklist below.
If you select “yes” to all criteria in Column A, the Collection of Routine Customer Feedback generic
clearance mechanism can be used. If you select “yes” to any criterion in Column B, the Collection of
Routine Customer Feedback generic clearance mechanism cannot be used.
Column A
The information gathered will only be used
internally to CDC.
[ X ] Yes [ ] No
Data is qualitative in nature and not generalizable
to people from whom data was not collected.
[ X ] Yes [ ] No

Column B
Information gathered will be publicly released or
published.
[ ] Yes [ X ] No
Employs quantitative study design (e.g. those that
rely on probability design or experimental
methods)
[ ] Yes [ X ] No
Sensitive questions will be asked (e.g. sexual
orientation, gender identity).
[ ] Yes [ X ] No

There are no sensitive questions within this
collection (e.g. sexual orientation, gender
identity).
[ X ] Yes [ ] No
Collection does not raise issues of concern to any
other Federal agencies.
[ X ] Yes [ ] No
Data collection is focused on determining ways to
improve delivery of services to customers of a
current CDC program.
[ X ] Yes [ ] No

Other Federal agencies may have equities or
concerns regarding this collection.
[ ] Yes [X ] No
Data will be used to inform programmatic or
budgetary decisions, for the purpose of program
evaluation, for surveillance, for program needs
assessment, or for research.
[ ] Yes [ X ] No

The collection is targeted to the solicitation of
opinions from respondents who have experience
with the program or may have experience with the
program in the future.
[ X ] Yes [ ] No
Did you select “Yes” to all criteria in Column A?
If yes, the Collection of Routine Customer Feedback generic clearance mechanism may be
appropriate for your investigation. You may proceed with this form.
Did you select “Yes” to any criterion in Column B?
If yes, the Collection of Routine Customer Feedback generic clearance mechanism is NOT
appropriate for your investigation. Stop completing this form now.

1

TITLE OF INFORMATION COLLECTION: App and Web Usability Study for CDC’s STD
Treatment Guidelines

PURPOSE:
The results of this information collection will contribute to CDC’s Division of STD Prevention’s
(DSTDP) efforts to provide clinicians with quick and current STD treatment information. At
present, DSTDP shares updated treatment guidelines with the public through the STD Treatment
Guidelines Mobile Application (STD Treatment Guidelines App) and Website (STD Treatment
Guidelines Site). The application is meant for quick clinical support, while the website provides
in depth guidance and resources. The STD Treatment Guidelines will be updated in 2020. In
preparation for the 2020 release’s new content and design, DSTDP staff would like to conduct
usability assessments with care providers who encounter STD’s in their practice. DSTDP is
tasking CDC’s Informatics Innovation Unit with usability testing of the app and website
guidelines. The goal of the study is to receive feedback on content, page layout, plain language,
information architecture, findability, navigation flow, and overall usability of DSTDP’s STD
Treatment Guidelines application and website.

DESCRIPTION OF RESPONDENTS:
Respondents will include 45 care providers who encounter STD’s in various clinical settings.
Respondents will be required to speak and understand English and must be 18 years or older.
The following criteria will be used to select care providers:
 Falls into one of the following categories, in order of priority:
1. Primary care (Medical Doctors—MDs, Nurse Practitioners—NPs, Physician
Assistants—PAs)
2. OB/GYN (MDs, NPs, PAs)
3. Emergency rooms/urgent care (MDs, NPs, PAs)
4. Pediatrics/adolescent medicine (MDs, NPs, PAs)
5. STD specialty clinic providers (MDs, NPs, PAs)
6. Dermatologists (important, but don’t treat a lot of STDs)
 Years of experience (a range of experience will be represented)
 Preference will be given to 2015 STD Treatment Guidelines app users
1. Devices used (a fairly even split of Android and iOS)

TYPE OF COLLECTION: (Check one)
Instruction: Please sparingly use the Other category

[ ] Customer Comment Card/Complaint Form
[ X ] Usability Testing (e.g., Website or Software
[ ] Focus Group

2

[ ] Customer Satisfaction Survey
[ ] Small Discussion Group
[ ] Other: ______________________

CERTIFICATION:
I certify the following to be true:
1. The collection is voluntary.
2. The collection is low-burden for respondents and low-cost for the Federal Government.
3. The collection is non-controversial and does not raise issues of concern to other federal
agencies.
4. The results are not intended to be disseminated to the public.
5. Information gathered will not be used for the purpose of substantially informing influential
policy decisions.

Name:________________________________________________
To assist review, please provide answers to the following question:
Personally Identifiable Information:
1. Is personally identifiable information (PII) collected? [ X ] Yes [ ] No
2. If Yes, is the information that will be collected included in records that are subject to the
Privacy Act of 1974? [ ] Yes [ X ] No
3. If Applicable, has a System or Records Notice been published? [ ] Yes [ X ] No
Gifts or Payments:
Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to
participants? [ ] Yes [ X ] No
If Yes: Please describe the incentive. If amounts are outside of customary incentives, please also
provide a justification

BURDEN HOURS
Category of Respondent
Health care providers: remote interviews

No. of
Participation
Respondents Time
45
30 minutes

Totals

45

30

Burden
22.5
hours
22.5

FEDERAL COST: The estimated annual cost to the Federal government is $ 3,795.19.
This estimate includes: FTE’s and fellows to draft the protocol, recruit participants, conduct the
usability interviews, analyze the results from the interviews, and write a report for CDC’s
DSTDP team.
If you are conducting a focus group, survey, or plan to employ statistical methods, please
provide answers to the following questions:

3

The selection of your targeted respondents
1. Do you have a customer list or something similar that defines the universe of potential
respondents and do you have a sampling plan for selecting from this universe?
[ X ] Yes
[ ] No
If Yes: Please provide a description of both below (or attach the sampling plan)
If No: Please provide a description of how you plan to identify your potential group of
respondents and how you will select them or ask them to self-select/volunteer
There is no official list of names or customers. However, IIU and DSTDP will recruit
respondents using the methods below:
 Send out a mobile push notifications to all current STD Tx Guide app users asking for
volunteers to provide feedback. Once users click on the notification it will forward them
to a landing page where they can submit their contact information.
 Send an email blast to registered National STD Curriculum team. The email will consist
of a link that forwards respondents to a landing page where they can submit their contact
information.
 Create a static banner on the STD Treatment Guidelines web site asking for volunteers to
provide feedback. Once users click on the banner it will forward them to a landing page
where they can submit their contact information.
100% of respondents will provide their contact information and answer 5 screener questions
through the landing page located: https://www.philab.cdc.gov/index.php/feedback/. IIU will
contact users who fall into the desired criteria and schedule an interview.

Administration of the Instrument
1. How will you collect the information? (Check all that apply)
[ X ] Web-based or other forms of Social Media
[ X ] Telephone
[ ] In-person
[ ] Mail
[ ] Other, Explain
2. Will interviewers or facilitators be used? [ X ] Yes [ ] No
IIU will conduct 45 remote interviews, each lasting approximately 30 minutes (Attachment A).
The interviews will be conducted using Skype for Business over the computer or phone. The
goal is to be able to interact and share screens remotely through Skype’s web-based tool.
However, if the participants do not have access to a computer, the interview will be held over the
phone using the dial in number provided through the Skype meeting invite. An interviewer and a
note taker will be present for the full duration. The respondents will consist of health
professionals. The number of each respondent type will be as follows:
Remote Interviews
3. Health Care Providers: n=45
a. Devices: n=23 iOS n=22 Android
b. Desktops: n=45

4

Please make sure that all instruments, instructions, and scripts are submitted with the
request.

Instructions for completing Request for Approval under the “Generic
Clearance for the Collection of Routine Customer Feedback”
TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the
subject of the request. (e.g. Comment card for soliciting feedback on xxxx)
PURPOSE: Provide a concise description of the purpose of this collection and how it will be
used. If this is part of a larger study or effort, please include this in your explanation.
DESCRIPTION OF RESPONDENTS: Provide a concise description of the targeted group or
groups for this collection of information. These groups must have experience with the program.
TYPE OF COLLECTION: Check one box. If you are requesting approval of other
instruments under the generic, you must complete a form for each instrument. The ‘Other’
category should be used only in the contexts in which the provided categories cannot reasonably
apply.
CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the
collection will be returned as improperly submitted or it will be disapproved.
Personally Identifiable Information: Provide answers to the questions.
Gifts or Payments: As a general matter, incentives are not appropriate for customer service
collections; however, incentives may be appropriate for focus groups or in-depth usability
studies, especially when participants must travel to a site to participate. In the latter
circumstance, the incentive should include travel costs. Customary incentives for focus groups
in the Federal government are $40 for a one-hour interview and $75 for a 90-minute focus group.
If you answer yes to the question, please describe the incentive and provide a justification for
amounts other than those cited above; justifications should be limited to Federal studies of a
similar design and subpopulation.
BURDEN HOURS:
Category of Respondents: Identify who you expect the respondents to be in terms of the
following categories: (1) Individuals or Households; (2) Private Sector; (3) State, local, or tribal
governments; or (4) Federal Government. Only one type of respondent can be selected.
No. of Respondents: Provide an estimate of the Number of respondents.
Participation Time: Provide an estimate of the amount of time required for a respondent to
participate (e.g. fill out a survey or participate in a focus group)
Burden: Provide the Annual burden hours: Multiply the Number of responses and the
participation time and divide by 60.
FEDERAL COST: Provide an estimate of the annual cost to the Federal government.
If you are conducting a focus group, survey, or plan to employ statistical methods, please
provide answers to the following questions:

5

The selection of your targeted respondents. Please provide a description of how you plan to
identify your potential group of respondents and how you will select them. If the answer is yes,
to the first question, you may provide the sampling plan in an attachment.
Administration of the Instrument: Identify how the information will be collected. More than
one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or
facilitators (e.g., for focus groups) used.
Please make sure that all instruments, instructions, and scripts are submitted with the
request.

6