Service Delivery GenIC Checklist

Check list for CDC/ATSDR GenIC clearance

Generic collection title and OMB number: 0920-1027

GenIC title: US Public Health Service Medical Officer Healthcare Access Survey

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 Preliminary data analysis is expected to begin 4 – 6 months after OMB approval and final analysis of the first year of data collection is expected to be completed 9 months after OMB approval. Data analyses include descriptive analyses and analyses stratified by demographic characteristics. Summary of the data to be presented at internal PHS, PHS Commissioned Officer Foundation, and PHS subcommittee meetings and not published.	Statistical Methods Provide the methods proposed for the genIC including recruitment or sampling methods The respondent universe includes all current United States Public Health Service (USPHS) physicians, as determined by records maintained by the USPHS Physician Professional Advisory Committee (PPAC). All eligible persons will be contacted by email and invited to participate in the survey. Participation will be voluntary. Limited de-identified demographic data will be submitted by each respondent who agrees to participate. Respondents will complete and submit the 4-question survey instrument. No personally identifiable data will be collected from respondents. We anticipate that the survey will take respondents approximately 10 minutes to complete. Data from all respondents will be collected in fillable pdfs and returned by email to the PPACs subcommittee. The email addresses of respondents will not be collected and the respondents’ email will be deleted once the completed survey form has been saved. Data will be abstract from the completed survey instruments by a CDC employee/PHS physician, cleaned by the CDC employee/PHS physician, and entered into a database for computer processing and analysis. The data will be analyzed using a cross-sectional analyses, investigating the percentage of PHS physicians responding affirmatively to each survey question. Gifts or Payments - the terms compensation, gift, and payment should not be used in the request Will an incentive be offered to respondents? [ ] Yes [ X ] No If yes, how much? Why necessary? Justification must be included in supporting statement A 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? Summary of the data to be presented to USPHS leadership and USPHS officers at internal USPHS, USPHS Commissioned Officer Foundation, and USPHS subcommittee meetings. Will results be published in a Journal? [ ] Yes [ X ] No For electronic collections, are screenshots included? [ ] Yes [ X ] No. the survey instrument will be sent as a fillable pdf. 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? [ ] Yes [ X ] No Final versions of all documents are required because GenICs cannot be amended after submission to HHS/OMB