[FALL 2022] Justification for Additional Response Options: Self-administered Web Survey, and Proxy Respondent

August 29, 2022

CDC requests approval for a non-substantive changes to OMB Control No. 0920-1307; Shigella Hypothesis Generating Questionnaire. The proposed changes will allow a respondent to provide information about himself/herself, a spouse, a child, other dependent, or other person (as specified by the respondent). The proposed changes will also allow the form to be completed as a self-administered web-based survey, in addition to the previously approved interviewer-administered mode of information collection.

 

Form Name: Shigella Hypothesis Generating Questionnaire 

Justification for changes: This non-substantive change request would allow CDC and state and local public health officials to collect the information from this questionnaire through a secure Epi Info survey platform. This change would allow for CDC to provide capacity support to state and local health departments, and for the SHGQ questionnaire links to be sent individually to cases involved in shigellosis clusters for self-administration. This change will reduce the burden of administering the questionnaire by phone for states/territories that do not have the capacity to conduct interviews for every ill case in a shigellosis cluster and will provide cases with an additional option to complete the SHGQ. We estimate that approximately 10% of information will be collected during an in-person interview; 70% of information will be collected by interviews conducted over the telephone; and 20% of information will be collected through the new web-survey option. We will monitor usage and adjust estimates accordingly.

 

Burden: 

Estimates of annualized burden hours for this change request will not be different from the previously approved forms.

 

Estimates of annualized burden hours for this change request: 0 hours.

The burden estimate for the form included in OMB Control No. 0920-1307: 1,125 hours.   

	Form Name	No. of Respondents	No. of responses per respondent	Avg. burden per response (hours)	Total burden (hours)
Approved	Shigella Hypothesis Generating Questionnaire	1,500	1	45/60	1,125

 

Description of Changes: 

The changes to the form are as follows: 

1. Removing interviewer prompts for self-administered questionnaire

1. Modifying instructions to allow for self-administered questionnaire

2. Changing language for (or your child) to (or the ill person) for each question throughout survey that asks for information about the illness, to include individuals completing the survey on behalf of another person.

 

Form	Current Question	Requested Change
Appendix G. Shigella Hypothesis Generating Questionnaire (SHGQ) – English (web-based version) Appendix E. Cuestionario Sobre La Shigella Para La Generacción de Hipótesis – Spanish web-based version	Introductory statement Section 1 Section 2 questions 1-3 Section 8, introduction and question 2 Ending statement	Introductory statement: Modified the introductory statement so appropriate for web-based survey Section 1: Removed non-applicable questions and rephrased questions so appropriate for web-based survey; clarifying who is taking survey Section 2 questions 1-3: rephrased questions so appropriate for web-based survey Section 8: rephrased introduction so appropriate for web-based survey Section 8 question 2: changed “don’t know” option to “prefer not to answer” to appropriately answer the sensitive questions Ending statement: rephrased so appropriate for web-based survey