Data Collection for Evaluation of Education, Communication, and Training Activities

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Cultural Sensitivity Assessment Tool	Form and Instruction	New	Available
Data Request to Health Departments	Form and Instruction	New	Available
Telephone Survey 2 Days before Last Scheduled Day To Report to Health Department	Form and Instruction	New	Available
Telephone survey within 3-5 days after airport survey	Form and Instruction	New	Available
In-person survey of traveler intercepted at the airport	Form and Instruction	New	Available
Form 0920-0932 Attachment F_Ebola CARE Kit_12 5 14	Form and Instruction	New	Available
Form 0920-0932 Attachment C_Final CARE Program_ECT_Telephone Interview Guide_12 10 2014	Form and Instruction	New	Available
Form 0920-0932 Attachment A_Final CARE Program_ECT_Intercept Interview Guide_12 10 14	Form and Instruction	New	Available
Statement of Consent for Semi-Structured Aptitude Questionnaire	Form and Instruction	New	Available
Statement of Consent for Pre-Knowledge Aptitude Survey	Form and Instruction	New	Available
Screener	Form	New	Available
Supporting Statement B FINAL 3_15_12-2.docx	Supporting Statement B	Uploaded 2012-03-20	Available
Appendix G SURVEY 3_15_12.doc	Supplementary Document	Uploaded 2012-03-20	Available
Appendix F INTERVIEW GUIDE 3_15_12.doc	Supplementary Document	Uploaded 2012-03-20	Available
Appendix E Focus Group Discussion Guide 3_15_12.docx	Supplementary Document	Uploaded 2012-03-20	Available
Attachment C - USCODE-2009-title42-chap6A-subchapII-partC-sec252.pdf	Supplementary Document	Uploaded 2012-03-20	Available
Attachment B - USCODE-2010-title8-chap12-subchapII-partII-sec1182.pdf	Supplementary Document	Uploaded 2012-03-20	Available
Attachment A - USC264.pdf	Supplementary Document	Uploaded 2012-03-20	Available
Attachment A - CFR-2010-title42-vol1-part71.pdf	Supplementary Document	Uploaded 2012-03-20	Available
Attachment A - CFR-2010-title42-vol1-part70.pdf	Supplementary Document	Uploaded 2012-03-20	Available
Supporting Statement A FINAL 3_15_12-2.docx	Supporting Statement A	Uploaded 2012-03-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215939	Evaluating the Effectiveness of Ebola CARE Plus Program	Form and Instruction	New	Cultural Sensitivity Assessment Tool
215939	Evaluating the Effectiveness of Ebola CARE Plus Program	Form and Instruction	New	Data Request to Health Departments
215939	Evaluating the Effectiveness of Ebola CARE Plus Program	Form and Instruction	New	Telephone Survey 2 Days before Last Scheduled Day To Report to Health Department
215939	Evaluating the Effectiveness of Ebola CARE Plus Program	Form and Instruction	New	Telephone survey within 3-5 days after airport survey
215939	Evaluating the Effectiveness of Ebola CARE Plus Program	Form and Instruction	New	In-person survey of traveler intercepted at the airport
214209	Evaluating the Effectiveness of Ebola CARE Program	Form and Instruction	New	Attachment F_Ebola CARE Kit_12 5 14
214209	Evaluating the Effectiveness of Ebola CARE Program	Form and Instruction	New	Attachment C_Final CARE Program_ECT_Telephone Interview Guide_12 10 2014
214209	Evaluating the Effectiveness of Ebola CARE Program	Form and Instruction	New	Attachment A_Final CARE Program_ECT_Intercept Interview Guide_12 10 14
210565	Evaluation of the TravAlert Electronic Messaging System	Other-WORD	New
207440	Evaluating the Effectiveness of Quick Response Codes in Educating Panel Physicians	Other-In-Depth Interview Guide	New
207440	Evaluating the Effectiveness of Quick Response Codes in Educating Panel Physicians	Form and Instruction	New	Statement of Consent for Semi-Structured Aptitude Questionnaire
207440	Evaluating the Effectiveness of Quick Response Codes in Educating Panel Physicians	Form and Instruction	New	Statement of Consent for Pre-Knowledge Aptitude Survey
206924	Evaluation of Adapted Health Education Materials for LEP Spanish-Speakers and Indigenous Migrants	Form	New	Screener
206924	Evaluation of Adapted Health Education Materials for LEP Spanish-Speakers and Indigenous Migrants	Other-Focus Group Script	New

ICR Details

OMB Control No: 0920-0932	ICR Reference No: 201203-0920-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Data Collection for Evaluation of Education, Communication, and Training Activities
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/07/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/23/2012
Terms of Clearance: Approved consistent with the following terms of clearance: For each information collection, a GenIC information collection request will be prepared and submitted to OMB for review and approval. Any changes to the ICR will also be submitted to OMB for review and approval.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2015	36 Months From Approved
Responses	166,500	0	0
Time Burden (Hours)	66,498	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is generic request for Evaluating Education, Communication, and Training Activities within the National Center for Emerging and Zoonotic Infectious Disease's Division of Global Migration and Quarantine Division (DGMQ).

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Authorizing Statute(s): US Code: 42 USC 361 Name of Law: Public Health Service
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 49487	08/10/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 76415	12/07/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Evaluating the Effectiveness of Ebola CARE Plus Program	None, None, None, None, None	In-person survey of traveler intercepted at the airport ,   Telephone survey within 3-5 days after airport survey ,   Telephone Survey 2 Days before Last Scheduled Day To Report to Health Department ,   Data Request to Health Departments ,   Cultural Sensitivity Assessment Tool
Evaluating the Effectiveness of Ebola CARE Program	0920-0932, 0920-0932, 0920-0932	Attachment A_Final CARE Program_ECT_Intercept Interview Guide_12 10 14 ,   Attachment C_Final CARE Program_ECT_Telephone Interview Guide_12 10 2014 ,   Attachment F_Ebola CARE Kit_12 5 14
Evaluating the Effectiveness of Quick Response Codes in Educating Panel Physicians	None, None	Statement of Consent for Pre-Knowledge Aptitude Survey ,   Statement of Consent for Semi-Structured Aptitude Questionnaire
Evaluation of Adapted Health Education Materials for LEP Spanish-Speakers and Indigenous Migrants	none	Screener
Evaluation of the TravAlert Electronic Messaging System

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	166,500	0	0	166,500	0	0
Annual Time Burden (Hours)	66,498	0	0	66,498	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This request is for a new Generic Clearance.

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Annual Cost to Federal Government: $4,670,000

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

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Common Form ICR:  No

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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: 03/23/2012

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