Checklist - screener

Check list for CDC/ATSDR GenIC clearance

Generic collection title and OMB number: 0920-1027

GenIC title: Formative Study to Inform HIV Screening and PrEP Resources for Health Care Providers —Screener

Generic Collection	GenIC
Statistical methods approved for the generic collection [ ] Yes [ X ] No Specify Sampling Method Sampling Size Type of Analysis used in the background Provide other parameters for the generic clearance including specifics about respondent universe, information collection methods, incentives, PII, plans for reporting or publication, additional scope limitations.	Statistical Methods Provide the methods proposed for the genIC including recruitment or sampling methods Gifts or Payments - the terms compensation, gift, and payment should not be used in the request Will an incentive be offered to respondents? [ X] Yes [ ] No If yes, how much? $250 per person Why necessary? Physicians are a population that is difficult to recruit to participate in research. A token of appreciation of up $100-$250 for primary care physicians was previously approved under the OMB package #0920-0775. A token of appreciation will ensure participation from a cross-section of physicians which will improve data quality by improving validity and reliability. This token of appreciation is consistent with those used in past interview studies between the contractor (RTI) and the focus group vendor. Please see Att C for in-depth justification of Token. Human Subjects Is IRB approval needed? [ ] Yes [ X ] No The study protocol can replace sup statement B. A one-pager can be used to explain what is in the protocol. Plans for Publication and Reporting Will this information be publically disseminated? [ ] Yes [ X ] No If yes, how? Will results be published in a Journal? [ ] Yes [ X ] No For electronic collections, are screenshots included? [X ] Yes [ ] No Are all language versions of documents included? [ X ] Yes English Only [ ] No GenICs cannot include assurances of confidentiality (except NCHS) – does this GenIC involve an assurance of confidentiality? [ ] Yes [ X ] No Have other materials (Reminders, e-mails, brochures, etc.) been included? [ X ] Yes [ ] No Final versions of all documents are required because GenICs cannot be amended after submission to HHS/OMB