[NCEZID] Shigella Hypothesis Generating Questionnaire

Forms and Documents

Document Name	Status
Form 0920-1307 Shigella Hypothesis Generating Questionnaire Form and Instruction	Modified
Att E Privacy Impact Assessment.pdf Supplementary Document	2023-10-06
Att D Human Subjects Determination.pdf Supplementary Document	2023-10-06
Att B Published 60-day Federal Register.pdf Supplementary Document	2023-09-18
Att A Authorizing Legislation_FINAL.pdf Supplementary Document	2023-10-06
Supporting Statement B_SHGQ_FINAL.docx Supporting Statement B	2023-10-06
Supporting Statement A_SHGQ.docx Supporting Statement A	2023-10-06

IC Document Collections

IC ID	Document Title	Status
242975	Shigella Hypothesis Generating Questionnaire Form and Instruction	Modified

ICR Details

OMB Control No: 0920-1307	ICR Reference No: 202309-0920-009
Status: Received in OIRA	Previous ICR Reference No: 202209-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1307
Title: [NCEZID] Shigella Hypothesis Generating Questionnaire
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/06/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved	11/30/2023
Responses	1,500	1,500
Time Burden (Hours)	1,125	1,125
Cost Burden (Dollars)	0	0

---

Abstract: There is currently no national, standardized hypothesis generating interview data collection instrument for use during single or multi state shigellosis cluster or outbreak investigations. The Shigella Hypothesis Generating Questionnaire (SHGQ) will be administered by state and local public health officials among cases as part of outbreak and cluster response. Is to define a core set of data elements to be used for hypothesis generation as part of investigations of clusters or outbreaks of shigellosis. The SHGQ will be used by federal, state, and local public health officials responsible for conducting interviews with reported cases of shigellosis in their jurisdiction in order to systematically assess core exposure elements and risk factors among cases of shigellosis.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 45217	07/14/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 69637	10/06/2023
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Shigella Hypothesis Generating Questionnaire	0920-1307, 0920-1307, 0920-1307, 0920-1307	SHIGELLA HYPOTHESIS GENERATING QUESTIONNAIRE (English version) ,   SHIGELLA HYPOTHESIS GENERATING QUESTIONNAIRE (Spanish version) Phone Interview ,   SHIGELLA HYPOTHESIS GENERATING QUESTIONNAIRE_Self-administered Web Survey (English) ,   CUESTIONARIO SOBRE LA SHIGELLA PARA LA GENERACIÓN DE HIPÓTESIS (Spanish version) Phone Interview

---

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,500	1,500	0	0	0	0
Annual Time Burden (Hours)	1,125	1,125	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $14,176

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/06/2023

---