Information Collection

Evaluation of the TravAlert Electronic Messaging System

IC 210565 under ICR 201203-0920-007 · OMB 0920-0932.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0932 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 3 - TravAlert Evaluation Recruitment and Screening Tool.docx	Other-WORD
Attachment 4 - TravAlert Evaluation Tally Sheet.docx	Other-WORD
Attachment 5 - TravAlert Evaluation Participant Information Sheet.docx	Other-WORD
Attachment 6 - TravAlert Evaluation Interview Guide.docx	Other-WORD
Attachment 7 - TraveAlert Messages.docx	Other-WORD
Attachment 8 - TravAlert Evaluation Protocol.pdf	Other-WORD
TraveAlert ECT Summary Statement A - GB Edits.docx TraveAlert ECT Summary Statement A - GB Edits	IC Document
TravAlert ECT Summary Statement B -GB edits.docx TravAlert ECT Summary Statement B -GB edits	IC Document
Attachment 1A - Public Health Service Act (42 U.S.C. 241), Section 301.pdf Attachment 1A - Public Health Service Act (42 U	IC Document
Attachment 1B - Public Health Service Act (42 U.S.C. 264), Section 361.pdf Attachment 1B - Public Health Service Act (42 U	IC Document
Attachment 1D - 42 CFR part 71.pdf Attachment 1D - 42 CFR part 71	IC Document
Attachment 1C - 42 CFR part 70.pdf Attachment 1C - 42 CFR part 70	IC Document
Attachment 2 - 60 Day Notice- 2011-20343.pdf Attachment 2 - 60 Day Notice- 2011-20343	IC Document
Attachment 9 - IRB Non-research Determination.pdf Attachment 9 - IRB Non-research Determination	IC Document

IC Title:

Evaluation of the TravAlert Electronic Messaging System

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 241 42 CFR 264

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD	Attachment 3 - TravAlert Evaluation Recruitment and Screening Tool.docx	No	No	Fillable Printable
Other-WORD	Attachment 4 - TravAlert Evaluation Tally Sheet.docx	No	No	Fillable Printable
Other-WORD	Attachment 5 - TravAlert Evaluation Participant Information Sheet.docx	No	No	Fillable Printable
Other-WORD	Attachment 6 - TravAlert Evaluation Interview Guide.docx	No	No	Fillable Printable
Other-WORD	Attachment 7 - TraveAlert Messages.docx	No	No	Fillable Printable
Other-WORD	Attachment 8 - TravAlert Evaluation Protocol.pdf	No	No	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	600	0	0	0	0	0
Annual IC Time Burden (Hours)	35	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
TraveAlert ECT Summary Statement A - GB Edits	TraveAlert ECT Summary Statement A - GB Edits.docx	02/28/2014
TravAlert ECT Summary Statement B -GB edits	TravAlert ECT Summary Statement B -GB edits.docx	02/28/2014
Attachment 1A - Public Health Service Act (42 U	Attachment 1A - Public Health Service Act (42 U.S.C. 241), Section 301.pdf	02/28/2014
Attachment 1B - Public Health Service Act (42 U	Attachment 1B - Public Health Service Act (42 U.S.C. 264), Section 361.pdf	02/28/2014
Attachment 1D - 42 CFR part 71	Attachment 1D - 42 CFR part 71.pdf	02/28/2014
Attachment 1C - 42 CFR part 70	Attachment 1C - 42 CFR part 70.pdf	02/28/2014
Attachment 2 - 60 Day Notice- 2011-20343	Attachment 2 - 60 Day Notice- 2011-20343.pdf	02/28/2014
Attachment 9 - IRB Non-research Determination	Attachment 9 - IRB Non-research Determination.pdf	02/28/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.