Completed checklist for submissions under 0920-1027

Check list for CDC/ATSDR GenIC clearance

Generic collection title and OMB number: 0920-1027

GenIC title: – Customer Service Satisfaction Assessment of TB Laboratory Site Visits conducted by CDC Laboratory Consultants – Online 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	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? [ ] 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? Data may be published in scientific and public health journals, presented at scientific meetings, and shared with USPHS leadership. Will results be published in a Journal? [ ] Yes [ ] 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? [ ] Yes [ X ] No Final versions of all documents are required because GenICs cannot be amended after submission to HHS/OMB