SO/GI Survey

Form Approved
OMB No. 0920-0728
Expiration Date 02/28/2021

Brief Assessment of Data Collection for Sexual Orientation & Gender Identity Data Elements in STD Reporting
Division of STD Prevention - 2019
1)

State/Project Area____________________________________________________________

2)

Is there a data element in your STD surveillance data management system to record patient sexual orientation?
Yes
No
a.

3)

If yes, when was this data element added? Month_____, Year_____

Is there a data element in your STD surveillance data management system to record patient gender identity?
Yes
No
a.

If yes, when was this data element added? Month_____, Year_____

b.

If yes, prior to implementing NETSS record layout version 5 (which includes a variable for reporting data on gender
identity through NNDSS), what ‘sex’ was selected for transgender persons?___________________________

c.

If no, do you capture transgender as a valid response code for ‘Sex’ of patient (i.e., Trans, MTF, FTM, etc.)?
Yes

4)

No

In order to report SO/GI data to CDC in your NETSS transmissions, did you need to modify your STD surveillance data
management system?
Yes
No
a.

If yes, please indicate the impact of this change:

Minor (simple coding) Medium (application upgrade) Major (Multiple Coding Revisions)
b.

If yes, please estimate the financial cost of these modifications:

Hours of work _______ x Cost per Hour $________=Total Cost $___________
5)

How are SO/GI data currently collected in your jurisdiction for cases of STDs reported through NNDSS? Check all that apply
for each STD.
On
laboratory
reports

On case
reports
submitted
by
providers

During
provider
follow-up
calls/faxes

From
electronic
case
reporting

During
surveillancespecific
patient
interviews

During
disease
investigation/
partner
services
interventions

Other
(Describe)

Chlamydia
Gonorrhea
Syphilis

CDC estimates the average public reporting burden for this collection of information as 15 minutes 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 burden to CDC/ATSDR
Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0728).