Template-Customer Feedback_ TB Site Visit_Online

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

TITLE OF INFORMATION COLLECTION: – TB Laboratory Site Visit Evaluation: Six-month Follow-up-Online Survey

PURPOSE: The purpose of this activity is to assess the impact of site visits by Laboratory Capacity Team (LCT) Consultants by collecting feedback from Public Health Laboratory (PHL) Tuberculosis (TB) Supervisors or their designees concerning implementation of recommendations to improve laboratory performance. The Laboratory Branch (LB) of the Division of Tuberculosis Elimination (DTBE) will use this collection of information from PHL to assess the effectiveness site visits by determining which recommendations PHL TB Supervisors found helpful and how they were implemented. Reasons for not implementing recommended changes in laboratory practice will also be collected and analyzed. By determining barriers to change, the DTBE will be guided to target resources more effectively to assist TB PHL reach performance benchmarks.

Information will be collected from 58 PHL TB Supervisors or their designees using a web-based assessment designed and administered by the LCT using SurveyMonkey software. The questionnaire contains 7 multiple choice or fill in the blank questions (appendices 1&2). Information will be collected approximately six months following a site visit by a LCT Consultants to allow time for PHL TB Supervisors to implement changes in laboratory procedures based on their recommendations. The questionnaire link will be emailed to PHL TB Supervisors or their designees. Responses will be automatically compiled by SurveyMonkey and then exported to Excel and SPSS for detailed analysis.

Data will be analyzed by CDC project officer and/or CDC project team members and discussed internally within Laboratory Branch and DTBE.

DESCRIPTION OF RESPONDENTS: CDC will field its customer service survey to a total of 58 state, city, and local TB laboratory supervisors or their designees who are supported, in part, by CDC TB Elimination and Laboratory Cooperative Agreement.

TYPE OF COLLECTION: (Check one)

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

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

[ ] Focus Group [X] Other: Customer Feedback Survey-Online

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: Mitchell Yakrus, (may2@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 [ X] 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

No honorarium will be provided for participants of the online survey.

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden Hours
PHL	58	15/60	14.5
Totals	58	15/60	14.5

FEDERAL COST: The estimated annual cost to the Federal government is: $17,000.

This estimate is based on the number of hours for instrument development, pilot testing, OMB package preparation, data collection, data coding and entry, quality control, data analysis, report preparation by a Microbiologist (GS 13).

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

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

The respondent universe includes all 58 state, local, and territorial public health laboratory TB supervisors or their designees who are supported, in part, by CDC TB Elimination and Laboratory Cooperative Agreement. All 58 PHL will receive site visits by LCT consultants and each laboratory supervisor will be invited to participate in the six-month follow-up assessment. To maximize participation, each potential respondent will be sent a reminder email (Appendix 3)

if no response is received online two weeks following the initial attempt.

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

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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