genIC Request

Request for genIC Approval
CDC/ATSDR Formative Research and Tool Development
0920-1154
CIO: National Center for Environmental Health
PROJECT TITLE: Formative Research to Identify Common and Unique Barriers to the Exchange of
Hospitalization and Emergency Department Data
PURPOSE AND USE OF COLLECTION: The purpose of this information collection is to gather
information on practices and barriers to health outcomes data collection and use in the Tracking
Program. Information from this formative needs assessment will inform CDC on the current status of
the Tracking Program’s hospitalization data ecosystem and agency capacities. The information
collected will allow CDC to better understand knowledge gaps and perceived barriers to improving
the quality of administrative data in the Tracking Network. CDC will then be able to develop
resources that can provide technical solutions for more efficient and timely data exchange.
DESCRIPTION OF RESPONDENTS: Respondents will include up to 26 state and city principal
investigators or principal managers, who are recipients of CDC's Environmental Public Health
Tracking cooperative agreement (CDC-RFA-EH14-1403 and CDC-RFA-EH14-1405).
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. Information gathered will not be used to substantially inform influential policy decisions.
5. The study is not intended to produce results that can be generalized beyond its scope.
Name: Alisha A. Etheredge
To assist review, please answer the following questions:
Personally Identifiable Information:
1. Is personally identifiable information (PII) collected? [ X ] Yes [ ] 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

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BURDEN HOURS

Category of Respondent

State and local health
departments

Form Name

No. of
Respondents

Participation
Time (minutes)

Burden in Hours

Pre-notice

26

5

2

CDC Tracking
Hospitalization Data
Needs Assessment
Tool

26

255

111

Totals

113

FEDERAL COST: The estimated annual cost to the Federal government is $125,000, which
includes the costs of the cooperative agreement with NAHDO.

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 for the survey includes all program investigators (PIs)/program managers
(PMs) in 26 states or cities funded by the CDC Environmental Public Health Tracking Program
(Tracking program) in 2019. The total for this respondent universe is 26. Each PI/PM will receive an
email from NAHDO to participate in the survey on behalf of the represented state or city. CDC has a
list of email addresses for each PI/PM, as they are funded recipients of CDC's Environmental Public
Health Tracking cooperative agreement (CDC-RFA-EH14-1403 and CDC-RFA-EH14-1405).

Administration of the Instrument
1. How will you collect the information? (Check all that apply)
[ X ] Web-based or other forms of Social Media
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[ ] Telephone
[ ] In-person
[ X ] Mail
[ ] Other, Explain
2. Will interviewers or facilitators be used? [ ] Yes [ X ] No

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