PIA Form

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Privacy Impact Assessment Form
v 1.47.4
Status Draft

Form Number

F-48574

Form Date

Question

Answer

1

OPDIV:

CDC

2

PIA Unique Identifier:

P-4950231-463145

2a Name:

1/9/2020 10:18:52 AM

Quality Assessment Program (QAP)
General Support System (GSS)
Major Application

3

Minor Application (stand-alone)

The subject of this PIA is which of the following?

Minor Application (child)
Electronic Information Collection
Unknown

3a

Identify the Enterprise Performance Lifecycle Phase
of the system.

Operations and Maintenance
Yes

3b Is this a FISMA-Reportable system?

4

Does the system include a Website or online
application available to and for the use of the general
public?

5

Identify the operator.

6

Point of Contact (POC):

7

Is this a new or existing system?

8

Does the system have Security Authorization (SA)?

8b Planned Date of Security Authorization

No
Yes
No
Agency
Contractor
POC Title

PUBLIC HEALTH ADVISOR

POC Name

Jennifer E. Buigut

POC Organization NCEZID
POC Email

cko1@cdc.gov

POC Phone

770.488.4552
New
Existing
Yes
No
April 2, 2020
Not Applicable

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11 Describe the purpose of the system.

The Quality Assessment Program (QAP) system was developed
by the Division of Global Migration and Quarantine (DGMQ),
Immigrant, Refugee and Migrant Health Branch to record and
track data on over 1,200 panel physicians in over 600 panel
sites in various countries to ensure the quality of overseas
medical screening examinations for visa applicants. It serves as
a repository for site evaluations conducted by DGMQ QAP
teams of physicians and laboratorians, who recommend
remediation, site removal, training, and/or consultation based
on CDC guidelines.

Information collected includes:
(1) For the facility: Latitude and longitude of City’s center,
Country, State, site visit purpose, facility address, facility email,
facility fax, facility name, facility postal code;
(2) For the Supervisor: First name last name, middle initial (MI),
site address, site email, site fax, site latitude and longitude, site
Describe the type of information the system will
phone;
collect, maintain (store), or share. (Subsequent
(3) For the Physician: Address, physician cell, physician email,
12
questions will identify if this information is PII and ask physician fax, physician first name last name, MI, physician
about the specific data elements.)
postal code, problem, problem report, site visit date, user
entering data first name, middle, and user id (not for
authentication purposes).
QAP does not store user identification or password for access.
Authentication is accomplished via Active Directory (AD). AD is
a separate system with its own PIA.
QAP was developed to record and track physician data in over
600 panel sites in various countries to ensure the quality of
overseas medical screening examinations for visa applicants.
Site visit evaluations are conducted by DGMQ QAP teams of
physicians and laboratorians. The site visits are based on the
volume of migrants and disease prevalence rates. Information
captured during the site visits are compiled into a report also
referred to as a Trip Report or Panel Physician Evaluation. Trip
Reports are shared within the division and with the respective
U.S. Embassy for a particular panel site.

Provide an overview of the system and describe the
13 information it will collect, maintain (store), or share,
either permanently or temporarily.

The system stores information obtained during these DGMQ
site visits, and maintains panel physician and facility
evaluations. Information collected includes:
(1) For the facility: Latitude and longitude of City’s center,
Country, State, site visit purpose, facility address, facility email,
facility fax, facility name, facility postal code;
(2) For the Supervisor: First name last name, middle initial (MI),
site address, site email, site fax, site latitude and longitude, site
phone;
(3) For the Physician: Address, physician cell, physician email,
physician fax, physician first name last name, MI, physician
postal code, problem, problem report, site visit date, user
entering data first name, middle, and user id (not for
authentication purposes).
QAP does not store user identification or password for access.
Authentication is accomplished via Active Directory (AD). AD is
a separate system with its own PIA.

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Yes

14 Does the system collect, maintain, use or share PII?

15

No

Indicate the type of PII that the system will collect or
maintain.

Social Security Number

Date of Birth

Name

Photographic Identifiers

Driver's License Number

Biometric Identifiers

Mother's Maiden Name

Vehicle Identifiers

E-Mail Address

Mailing Address

Phone Numbers

Medical Records Number

Medical Notes

Financial Account Info

Certificates

Legal Documents

Education Records

Device Identifiers

Military Status

Employment Status

Foreign Activities

Passport Number

Taxpayer ID
Fax
User Id
City Longitude and Latitude
Site Longitude and Latitude
Employees
Public Citizens
16

Business Partners/Contacts (Federal, state, local agencies)

Indicate the categories of individuals about whom PII
is collected, maintained or shared.

Vendors/Suppliers/Contractors
Patients
Other

17 How many individuals' PII is in the system?
18 For what primary purpose is the PII used?
19

Describe the secondary uses for which the PII will be
used (e.g. testing, training or research)

500-4,999
PII is obtained to record the Site, Supervisor, Physician, and
individual performing the site visit.
N/A

20 Describe the function of the SSN.

N/A

20a Cite the legal authority to use the SSN.

N/A

Public Health Service Act, Section 301, "Research and
Identify legal authorities governing information use Investigation," (42 U.S.C. 241); and Sections 304, 306 and 308(d)
21
which discuss authority to grant assurances of confidentiality
and disclosure specific to the system and program.
for health research and related activities (42 U.S.C. 242 b, k, and
m(d)).

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22

Are records on the system retrieved by one or more
PII data elements?

Yes
No
Directly from an individual about whom the
information pertains
In-Person
Hard Copy: Mail/Fax
Email
Online
Other
Government Sources

23

Within the OPDIV
Other HHS OPDIV
State/Local/Tribal
Foreign
Other Federal Entities
Other

Identify the sources of PII in the system.

Non-Government Sources
Members of the Public
Commercial Data Broker
Public Media/Internet
Private Sector
Other
23a

Identify the OMB information collection approval
number and expiration date.

24 Is the PII shared with other organizations?
Describe the process in place to notify individuals
25 that their personal information will be collected. If
no prior notice is given, explain the reason.
26

Is the submission of PII by individuals voluntary or
mandatory?

Describe the method for individuals to opt-out of the
collection or use of their PII. If there is no option to
27
object to the information collection, provide a
reason.
Describe the process to notify and obtain consent
from the individuals whose PII is in the system when
major changes occur to the system (e.g., disclosure
28 and/or data uses have changed since the notice at
the time of original collection). Alternatively, describe
why they cannot be notified or have their consent
obtained.
Describe the process in place to resolve an
individual's concerns when they believe their PII has
29 been inappropriately obtained, used, or disclosed, or
that the PII is inaccurate. If no process exists, explain
why not.

N/A. Information is not collected pursuant to the Paperwork
Reduction Act (PRA).
Yes
No
Individuals are asked for their business contact information
during the course of the Site Visit and are told that this
information is will be included in the site visit report.
Voluntary
Mandatory
Users cannot opt-out of collection of their PII. The information
maintained on Panel Physicians is business contact
information which is required for other purposes as well,
including training announcements, important updates and
general communications should questions arise.
Participating Sites will be notified when major changes occur
to the system using the contact information on file. The sites
can be notified either by phone, email, or with a letter to the
physical mailing address. The Point of Contact on this form is
responsible for notifying the sites.

Any individual who has concerns may contact the CDC site visit
point of contact to resolve any issues.

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Describe the process in place for periodic reviews of
PII contained in the system to ensure the data's
30
integrity, availability, accuracy and relevancy. If no
processes are in place, explain why not.

Consular Sections (US State Department) are required to
inform us of any changes to panel physicians within their
countries, and we make changes to the database based on
those notifications. Panel physicians will also let us know
when their contact info has changed for any reason. Through
those two mechanisms, the program is regularly updating the
database to maintain accuracy based on information received.
Users

Administrators

31

Identify who will have access to the PII in the system
and the reason why they require access.

Developers

Contractors

Users have access to the data in order
to complete the site visit report.
Administrators have access to the data
to ensure the quality of the data in the
database and add users as determined
by the program.
Developers have access to the data in
order to generate SQL queries for the
users and needed.
Users, Developers, and Administrators
may be CDC direct contractors. They
would have access to the data based
on their role as explained above.

Others
Describe the procedures in place to determine which The program first evaluates whether the individual has a need
32 system users (administrators, developers,
for access to the system. If the individual's manager
contractors, etc.) may access PII.
determines that access to the system is required for the
Describe the methods in place to allow those with
33 access to PII to only access the minimum amount of
information necessary to perform their job.

Least privilege, Role Based Access methods are used to allow
those with access to PII to only access the minimum amount of
information necessary to perform their job. The system
administrator is responsible for setting up the user access to
the system based on the CDC user id and the permissions
assigned to it.

Identify training and awareness provided to
personnel (system owners, managers, operators,
contractors and/or program managers) using the
34
system to make them aware of their responsibilities
for protecting the information being collected and
maintained.

Annual CDC Security Awareness Training (SAT) and Privacy
training is mandatory for all CDC system users.

Describe training system users receive (above and
35 beyond general security and privacy awareness
training).

Annual Role Based Security Training is required for IT
Administrators.

Do contracts include Federal Acquisition Regulation
36 and other appropriate clauses ensuring adherence to
privacy provisions and practices?

Describe the process and guidelines in place with
37 regard to the retention and destruction of PII. Cite
specific records retention schedules.

Yes
No
Records are maintained and destroyed according to the CDC
General Records Schedule (GRS) 20.6. Records are maintained
in agency for five years. Disposal methods include erasing
computer tapes, burning or shredding paper materials or
transferring records to the Federal Records Center when no
longer needed for evaluation and analysis. Records are
destroyed by paper shredding process when 10 years old,
unless needed for further study.

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Administrative - Access to the application is approved by the
individuals supervisor indicating that the user has a need to
know the information on the system.
Describe, briefly but with specificity, how the PII will
38 be secured in the system using administrative,
technical, and physical controls.

Technical - The CDC user id is encrypted while stored in the
Active Directory system.
Physical- The server is housed on CDC property with gate
security guards at the entrances to the property, individual
user access credentials are required for each non-public
building , floor, and office. Closed circuit TV is also used by the
internal security guards to check for and grant access to
authorized individuals.

General Comments

OPDIV Senior Official
for Privacy Signature

Beverly E.
Walker -S

Digitally signed by
Beverly E. Walker -S
Date: 2020.02.28 16:54:47
-05'00'

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