FastTrack GenIC Request for Approval

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1027)

TITLE OF INFORMATION COLLECTION: US Public Health Service Medical Officer Healthcare Access Survey

PURPOSE:

Mental health disorders are common among adults in the United States. Persons with mental health disorders often face substantial barriers to mental healthcare access. Physicians in the United States Public Health Service (USPHS) Commissioned Corps treat patients in medically underserved areas and respond to public health emergencies. A survey of USPHS physicians conducted in 2010 found that 14% of respondents reported that a USPHS physician or family member had difficulty accessing mental healthcare in the preceding 12 months

The goal of the collection is to estimate self-reported access to healthcare and mental healthcare among PHS physicians and dependents in order to identify opportunities for improving access to healthcare and mental healthcare among PHS physicians and dependents. Data will be collected using a fillable pdf survey instrument – converted from the Word document (Attachment 2) from PHS physicians.

The data will be analyzed using a cross-sectional analyses, investigating the percentage of PHS physicians responding affirmatively to each survey question.

DESCRIPTION OF RESPONDENTS:

The respondents will physicians in the USPHS. We plan to conduct a survey of 790 USPHS physicians to investigate current perceived access to healthcare and mental healthcare and identify opportunities for greater access. We anticipate the respondents will take 10 minutes to complete the survey for a total of 132 burden hours. No payment or gift is provided to respondents.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software) [ ] Small Discussion Group

[ ] Focus Group [x] Other: Fillable PDF

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.

6. 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.

Name: Robert Kirkcaldy, MD, MPH (hgl8@cdc.gov)

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [x ] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [] Yes [x ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Physicians in the United States Public Health Service (USPHS)	790	10 minutes	132 hours

FEDERAL COST: The estimated annual cost to the Federal government is $ $16,303.94.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

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

The respondents will be physicians currently in the USPHS.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[x] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [ x ] No

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