CMEC Generic Clearance Memo to OMB

MEMORANDUM

TO: Robert Sivinski

Office of Statistical and Science Policy

Office of Management and Budget

THROUGH: Kevin M. Scott, PhD

Acting Director

Bureau of Justice Statistics

Shelley Hyland, PhD

Senior Statistical Advisor

Bureau of Justice Statistics

Heather Brotsos

Deputy Director, Statistical Operations

Bureau of Justice Statistics

Alexia Cooper, PhD

Chief, Law Enforcement Statistics Unit

Bureau of Justice Statistics

FROM: Connor Brooks

Statistician, Law Enforcement Statistics Unit

Bureau of Justice Statistics

DATE: November 14, 2023

SUBJECT: BJS request for Office of Management and Budget (OMB) Clearance to conduct: 1) outreach to verify reporting units for the 2023 Census of Medical Examiner and Coroner Offices (CMEC) and 2) cognitive interviews to finalize the CMEC survey instrument, under BJS’s generic clearance agreement OMB Number 1121-0339

Introduction

This generic clearance is to request approval to conduct two activities in preparation for the 2023 Census of Medical Examiner and Coroner Offices (CMEC) under the Bureau of Justice Statistics (BJS’s) generic clearance agreement (OMB Number 1121-0339). In 2024, BJS is planning to conduct the CMEC, which was last conducted in 2019 for a 2018 reference year. This will be the third iteration of CMEC. The two prior reports by BJS¹ remain the only comprehensive sources of basic data about the U.S. medicolegal death investigation system. BJS’s reports make clear that medical examiners and coroners (MECs) vary widely across all measures (e.g., jurisdiction size and type, caseload, staffing, procedures performed, record retention, use of national databases, operation, and budget).

The purpose of the 2023 CMEC (to be fielded in 2024-2025) is to survey the universe of approximately 2,200 MECs that conduct medicolegal death investigations in the U.S. The purpose of the CMEC data collection is to gather and report information on: 1) administration of MEC offices, including but not limited to accreditation and budget; 2) staffing, including but not limited to employee training and certification; 3) workload, including but not limited to referred and accepted cases, backlogs, and autopsies; and 4) policies and procedures, including but not limited to those for disposition of remains, unidentified decedents, record keeping, and standardization of data. In addition, the 2023 CMEC will include approximately 700 additional Justices of the Peace (JPs) in Texas who were not included in the 2018 CMEC. The CMEC will provide these JPs with the same instrument as other MEC offices.

In preparation of the 2023 CMEC, BJS has revised the survey instrument and is seeking OMB generic clearance to 1) Verify and update the frame using email and telephone outreach to confirm or collect contact information for the MEC frame, and 2) Conduct cognitive interviews to test the revised survey instrument for clarity and interpretation of the questions and answer options. More details about each of these requests follow.

Task 1: Request for Frame Verification Telephone Outreach Effort

To construct the frame, BJS, in partnership with RTI, will review the final 2018 CMEC universe file (N = 2,200) against the National Directory of Law Enforcement Administrators (NDLEA) directory,² which is a real-time database that includes MECs. We will merge both lists to ensure coverage, identify any new offices, remove any duplicate entries, and update any contact information in preparation for our verification calling effort. It is anticipated that through this comparison, we will identify up to 30 new offices to add to the frame. Additionally, the website https://www.tjctc.org/JP-Constable-Directory.html contains a directory of all the JPs in Texas that will be included in the verification process.

To that end, BJS requests clearance from OMB to collect or confirm contact information and addresses from 2,230 MEC offices through a combined web-based collection and telephone collection, and about 700 Justices of the Peace (JPs) through an email-only collection. We aim to conduct this verification call effort from February 2024 through April of 2024.

The verification effort will start with BJS and RTI comparing email addresses that were provided in the 2018 administration with the NDLEA database with the existing CMEC frame. The team will send an email invitation to all 2,230 MEC offices with login credentials to complete the verification option online. The email will provide an overview of the CMEC and invite them to log into the portal and verify their contact information (Appendix A-1). The email will indicate that the team will call them in two weeks to verify their contact information by telephone if they opt not to verify their information on the website. Based on previous experience, we anticipate that about one-third of units will opt for the login verification response. A separate email will be sent to the approximately 700 Justices of the Peace so that the team can verify their contact information, but this outreach will be done via email only (Appendix A-2). The verification form will be programmed and located at the same URL for the full CMEC data collection (www.bjscmec.org). Appendix A-3 provides the list of the proposed verification questions that will be sent to MEC offices and JPs. If the respondent has not verified their information approximately one week after initial outreach, one email reminder will be sent that reiterates the messaging for both the MECs and JPs (Appendix A-4 and Appendix A-5).

The project team anticipates that one third of MEC offices (approximately 743 units) will respond to the email invitation to confirm their contact information using a web-based portal and about two thirds (approximately 1,487 MECs) will need to have their contact information verified via telephone. The telephone verification effort will involve project staff calling each of the MECs that did not confirm their contact information online. These calls will confirm the information we have currently on record including the MEC office official name, office address, and the name and contact information for the coroner or medical examiner. Appendix A-6 provides the verification call script. The project team will conduct only email and web verification for JPs. JPs will not receive phone call follow-ups.

Both online and telephone verification efforts will also help identify a survey point of contact most properly suited to answer the 2023 CMEC survey questions. In addition, three questions will be used to ascertain the MEC (or JP) office’s eligibility for the study. MEC offices that do not conduct medicolegal death investigations, sign death certificates, or determine when autopsies should be conducted are out of the scope of the 2023 CMEC and therefore should not be further burdened. The results of these calls will be documented and uploaded into the case management system to be used for all future communications with eligible MECs. The last question will ask what survey mode the MEC prefers so that we can tailor the subsequent mailout accordingly.

Burden Hours for the Frame Verification Effort

Table 1 provides a summary of the burden estimate for this effort. It is expected that web respondents, both MECs and JPs, will require about 5 minutes to confirm their contact information online using the secure portal. It is anticipated that the telephone respondents will need an average of 5 minutes to identify an appropriate person within the office to answer the questions if the initial respondent is unable to answer the questions. This estimate includes the time necessary to call respondents back if they indicate they are not available at the time, and we need to call back. For respondents who are able to answer the questions, the call is estimated to require about 5 minutes.

Table 1. Burden Estimate for the Frame Verification Effort

Task	Average burden per MEC	Total estimated burden hours
Confirm contact information via web for approximately one-third of MECs (n=743 units)	5 minutes	743 respondents x 5 minutes = 62 hours
Identify appropriate respondent and confirm information for verification questions via telephone (n=1,487 units)	10 minutes	1,487 respondents x 10 minutes = 248 hours
Confirm contact information via web for approximately 700 JPs	5 minutes	700 respondents x 5 minutes = 58 hours
Total respondent burden for all respondents = 368 hours

Task 2: Request for Cognitive Interviewing

BJS also requests clearance to conduct up to two rounds of cognitive testing of the 2023 CMEC instrument (up to 32 cognitive interviews in total). The project team will initially conduct 17 cognitive interviews for the first round of testing. If respondents’ feedback consistently indicate that certain questions are problematic, BJS and RTI plan to conduct an additional round of cognitive testing with the revised questions with up to 15 respondents. The second round of cognitive testing may also be considered if by the end of the first round of testing, participants are still raising unique issues and questions that have not been raised by other participants.

In preparation for this effort, the project team reviewed the 2018 CMEC instrument for completeness and clarity. The CMEC team also conducted a data quality assessment with the publicly available dataset to identify potentially problematic questions based on item response. Questions with high item missingness were identified as candidates for deletion or revision. In addition, an expert panel provided direction on survey revisions and provided input to make the questionnaire content relevant to the 2023 needs and demands of MEC offices. These efforts have resulted in a draft 2023 CMEC instrument that is ready for cognitive testing.

The cognitive interviewing plan is designed to assess the survey instrument in terms of general understanding, question and response wording, and survey design, all of which will help minimize survey burden. The goal of this effort is to understand how well the questions work when administered to a purposive subset of the survey’s target population, which will include an even mix of coroners and medical examiners with representation across large and small jurisdictions, and across geographical regions, including jurisdictions that border tribal areas.

BJS and the project team will select eleven coroners, eleven medical examiner offices, and ten Justices of the Peace to participate in interviews across both rounds of testing. We are including ten Justice of the Peace in our cognitive interviews to inform BJS if they should be included in the 2023 CMEC data collection.³ If the conducted cognitive interviews suggest that they can provide data, BJS will consider including them in the overall collection as part of a supplement to determine the feasibility of their inclusion in future years.

The cognitive testing sample will reflect a diverse set of offices based on: 1) Type of office: medical examiner, coroner, or Justice of the Peace; 2) Jurisdiction type: state, county, or regional; 3) Population serviced: less than 25k population served, 25k to <250k, or 250k or more (based on the 2022 Census population estimate); 4) Location of autopsies: internally or externally conducted; and 5) Operating in a private setting (e.g., doctor’s office) vs. fully public. Tables 2 and 3 provide an overview of the proposed cognitive testing sample for both rounds of testing. Other characteristics, such as elected vs. appointed (coroners), and additional unique circumstances (e.g., non-traditional MEC, such as sheriff coroners) will also be considered during selection.

Table 2. Target Number of Interviews for Round 1

Attribute	Coroner	Medical Examiner	Justice of the Peace	Total Count
Jurisdiction Type
District/County	6	4	5	15
Regional/State	0	2	0	2
Privatized Component
Yes	0	1	0	1
Partial (as MD)	0	2	0	2
No	6	3	5	14
Autopsy Location
Internal	2	4	0	6
External	4	2	5	11
Size of Jurisdiction
Less than 25,000 (small)	3	1	2	6
Between 25,000 and 250,000 (medium)	2	1	1	4
Over 250,000 (large)	1	4	2	7

Table 3. Target Number of Interviews for Round 2

Attribute	Coroner	Medical Examiner	Justice of the Peace	Total Count
Jurisdiction Type
District/County	5	3	5	13
Regional/State	0	2	0	2
Privatized Component
Yes	0	1	0	1
Partial (as MD)	0	2	0	2
No	5	2	5	11
Autopsy Location
Internal	1	3	0	4
External	4	2	5	11
Size of Jurisdiction
Less than 25,000 (small)	2	1	2	5
Between 25,000 and 250,000 (medium)	2	1	2	5
Over 250,000 (large)	1	3	1	5

Each of these characteristics is important to be represented among the cognitive testing panel because they reflect the diverse perspectives needed to ensure that the survey will resonate with and be understood by a diverse field and capture the intended data. If the project team encounters any refusals among the initial purposive sample, a substitute cognitive interview respondent will be identified that fits the general profile of the refusal across the primary office characteristics (e.g., a refusal coroner from the Midwest representing a medium-sized city/county would be replaced by a respondent with the same characteristics). To secure enough participants, the project team will initially select a primary sample of 32 coroners, medical examiner offices, and Justices of the Peace and a replacement sample of 32 of these offices. Both the primary and replacement samples will include 17 potential respondents for the first round of cognitive testing and 15 for the second round. These offices will be selected to reflect the characteristics described in table 2.

Using the scripts included in Appendix B, the project team will contact the prospective MEC or JP cognitive interview respondents to invite them to participate in 60-minute telephone/videoconference cognitive interviews via Teams or Zoom through video or audio only (at the request of the participant). All the invitations will be delivered via email (see email template in Appendix B-1). Once these invitations are sent, if the project team does not receive a response to the initial outreach within approximately one week, the project team will follow up by email to confirm willingness to participate and schedule the cognitive interview (see email template in Appendix B-2). A final outreach attempt will be made via phone if no response is received after the email follow-up (Appendix B-3).

Upon receiving confirmation of the office’s willingness to participate in the cognitive testing, we will send a follow-up email that proposes dates/times for the interview if/as needed (Appendix B-4). RTI recruiters will send a final confirmation email with agreed upon dates/times (Appendix B-5), as well as the consent form (Appendix C) and the census questionnaire (Appendix D). Because we are interested in how respondents understand and interpret questions rather than the actual answers to the questions, respondents will not be asked to complete the questionnaire and return it prior to the cognitive interview.

Participation in the cognitive test will be completely voluntary. All participants will be 18 years of age or older. Prior to the scheduled interview, the participants will be provided information that describes the interview, why they were chosen, what will happen during the discussion, the risks and benefits of participation, and details ensuring confidentiality (see Appendix C-1). At the time of the scheduled interview, staff will review these materials, including the consent form with the respondents. They will be given the option to refuse to answer a question at any time during interview. Since these are telephone/videoconference interviews, the interviewer will read the consent form to the participant and obtain verbal consent. After receiving verbal consent, the interviewer will check and sign the hard copy informed consent to have on record, certifying they have obtained the participant’s permission to continue with the interview (see Appendix C-2). Interviews will only be conducted if consent is obtained. If a participant refuses, they will be thanked for their time and consideration.

If the participant consents to audio recording, the interviews will be recorded to allow for accurate capture of responses and account of answers during the analysis stage. Audio recordings will be saved on the project team’s secured project share and will be deleted once the survey is finalized. Audio recordings will not be sent electronically or transferred outside of RTI to reduce the risk of an unauthorized party intercepting the recordings. A thank you email will be sent to participants within 48 hours of the completion of the cognitive interview (see Appendix B-6).

The survey topics in the questionnaire include:

• Section A: Administrative including type of office, jurisdiction served, and personnel

• Section B: Expenditures and funds including annual expenditures, expenditure categories, and funding sources

• Section C: Workload (i.e., cases and number of death investigations) including number of referrals, and accepted cases

• Section D: Specialized death investigations including procedures for unidentified remains and overdoses

• Section E: Records and evidence retention including computer records systems and archiving

• Section F: Resources including internet access, access to databases, training resources, and technologies

The testing protocol and example probes are presented in Appendix E. The respondents will see only the formatted survey and not the probing questions. Each cognitive interview, including probes, will take a maximum of 60 minutes. The cognitive testing protocol will introduce the participants to BJS’s 2023 CMEC goals (see Appendix F for the study show card), and guide participants through the questionnaire.

As respondents answer the questions, the interviewers will ask participants to note any aspects of the instruments that are unclear, any questions or topics omitted, or any answer choices or response categories missing or insufficient, or questions that should be struck or revised. Interviewers will also ask questions to check respondents’ understanding of the questions. During this cognitive testing phase, we will instruct participants to answer only those questions which they can readily answer; participants are not expected to conduct research to answer any questions. For those questions that are not readily answered without researching information, we will ask participants how they would find the information necessary to answer the question and who would be the person best suited to answer the question. To gauge burden, we will also ask participants how long they think it would take them to complete the form on their own, including any time necessary for research or involving other staff members.

Participants will not receive any compensation for the interview but will be thanked for their time and insights. The project team will review the feedback from the cognitive interviews and revise the survey instruments as necessary.

The full draft 2023 CMEC instrument is provided in Appendix D. Cognitive interviews will take place in September and October 2023. All information gathered from the CMEC cognitive testing efforts will be integrated into the full information clearance package that is expected to be submitted to OMB in February 2024.

As a member of the Office of Justice Programs/Centers for Disease Control Federal Medicolegal Death Investigation Interagency Working Group (MDI-IWG), BJS received feedback from the group on proposed changes to the instrument. The group was concerned about removing certain items proposed for removal by the expert panel. As such, BJS proposes asking about these items during cognitive interviewing (see Appendix H) to determine if they should be added back into the 2023 CMEC instrument.

Burden Hours for the Cognitive Interviews

The burden hour estimates are provided in the following tables. While up to 64 total offices may be contacted to secure the desired number of participants, only a total of 32 will be asked to actually participate in the cognitive interviews. Thus, the initial contact and scheduling allows for up to 64 respondents, the first round of testing for 17 respondents, and the second round for 15 respondents. The total burden estimate is 42.7 hours.

Table 4. Burden Estimate for Cognitive Interviews

Task	Average burden per respondent	Total maximum respondents	Total estimated burden hours
Initial contact and scheduling	10 minutes	64	10.7 hours
Complete cognitive interview including questionnaire completion, first round	60 minutes	17	17 hours
Complete cognitive interview including questionnaire completion, second round if needed	60 minutes	15	15 hours
Total respondent burden for all respondents = 42.7 hours

Timeline

Table 5. Timeline

Milestone	Start Date	End Date
Obtain OMB generic clearance	11/13/23	12/4/23
Recruitment and testing period	12/4/23	03/4/24
Analyze data and develop instrument recommendations	03/05/24	04/05/24
Draft final report	04/05/24	04/19/24
Verification effort	04/01/24	07/31/24

Informed consent

Participants will be provided information describing the project, the purpose and process of the interview, why they were chosen to participate, and details ensuring confidentiality (see Appendix C-1) prior to the start of the interview. At the beginning of the interview, staff will review these materials with participants. The informed consent script will announce the estimated length of the interview in advance, allowing the participant an opportunity to decline if the burden would be unacceptable. Cognitive interviewees will be asked their permission to record the interview. The interviewer will read the consent form to the participant to obtain verbal consent to participate and record the interview. After receiving verbal consent, the interviewer will check and sign the hard copy informed consent to have on record, certifying they have obtained the participant’s permission to continue with the interview (see Appendix C-2). Interviews will only be conducted if consent is obtained.

Data confidentiality and security

BJS is authorized to conduct this data collection under 34 U.S.C. § 10132. During testing identifying information including the participant’s name, the office for which they work, address, email, and telephone number will be collected. All information related to the cognitive interviews, including the recordings of interviews, will be stored on a secure drive at RTI with restricted access to those staff members who are directly involved in testing. To protect the identities of the respondents, no identifying information will be kept in the final data file. In addition, the recorded conversations of the interviews will be erased upon completion of the cognitive testing report. We estimate this to be one month after the pretest has ended. Once the instrument is revised and the summary report completed, all copies of the cognitive interview data will be destroyed.

All project staff are required to sign a pledge of confidentiality and privacy certificate which confirms the maintaining of data and following the procedures outlined above. Furthermore, all cognitive interviews will be conducted by project staff at RTI, who must complete official security training.

Institutional Review Board

The project team has obtained approval from RTI’s IRB to ensure the testing protocols are compliant with informed consent and data confidentiality standards (Appendix G).

Contact Information

Questions regarding any aspect of this project can be directed to:

Connor Brooks

CMEC Program Manager

Bureau of Justice Statistics

Office of Justice Programs

U.S. Department of Justice

810 7th Street NW

Washington, DC 20531

Office Phone: 202-598-1864

E-Mail: [email protected]

Appendix A:	2023 Census of Medical Examiner and Coroner Offices Verification Materials
Appendix B:	2023 Census of Medical Examiner and Coroner Offices Cognitive Testing Recruitment Materials
Appendix C:	2023 Census of Medical Examiner and Coroner Offices Cognitive Testing Informed Consent
Appendix D:	2023 Census of Medical Examiner and Coroner Offices Instrument
Appendix E:	2023 Census of Medical Examiner and Coroner Offices Cognitive Interviewing Protocol
Appendix F:	BJS’s 2023 Census of Medical Examiner and Coroner Offices Goals Showcard
Appendix G:	IRB Submission Confirmation
Appendix H:	2023 Census of Medical Examiner and Coroner Offices Appendix Dropped Questions

1 Hickman, M. J., Hughes, K. A., Strom, K. J., & Ropero-Miller, J. D. (2007). Medical examiners and coroners’ offices, 2004. Bureau of Justice Statistics, Office of Justice Programs, U.S. Department of Justice, Washington, DC.

Brooks, C. (2021, November). Medical Examiner and Coroner Offices, 2018 (NCJ 302051). Washington, DC: Bureau of Justice Statistics, Office of Justice Programs, U.S. Department of Justice. https://bjs.ojp.gov/content/pub/pdf/meco18.pdf

2 National Public Safety Information Bureau. Directories and data for public safety professionals. https://www.safetysource.com/index.cfm

3 Justices of the Peace (JPs) have been excluded from previous CMEC data collections because in most states they are not responsible for medicolegal death investigation (MDI) functions. This CMEC intends to assess the viability of including JPs in those states where they do have MDI functions.

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