Evaluating the Effectiveness of Ebola CARE Program

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 0920-0932 Evaluating the Effectiveness of Ebola CARE Program Form and Instruction
0920-0932 Attachment A_Final CARE Program_ECT_Intercept Interview Attachment A_Final CARE Program_ECT_Intercept Interview Guide_12 10 14 clean.docx Form and Instruction
0920-0932 Attachment C_Final CARE Program_ECT_Telephone Interview Attachment C_Final CARE Program_ECT_Telephone Interview Guide_12 10 2014 clean.docx Form and Instruction
0920-0932 Attachment F_Ebola CARE Kit_12 5 14 Attachment F_Ebola CARE Kit_12 5 14.pdf Form and Instruction
Final CARE Program_ECT Statement A_12 10 14 clean.docx Final CARE Program_ECT Statement A_12 10 14 IC Document
Final CARE Program_ECT Statement B_12 10 14 clean.docx Final CARE Program_ECT Statement B_12 10 14 IC Document
Attachment B - 60 Day FRN 0920-0932.pdf Attachment B - 60 Day FRN 0920-0932 IC Document
Attachment D_IRB Letter of Determination 12 5 14.docx Attachment E_Determination of Applicability of Human Subjects Regulation IC Document

Information Collection (IC) Details

IC Title:	Evaluating the Effectiveness of Ebola CARE Program	Agency IC Tracking Number:	15GZ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0932	Attachment A_Final CARE Program_ECT_Intercept Interview Guide_12 10 14	Attachment A_Final CARE Program_ECT_Intercept Interview Guide_12 10 14 clean.docx	Yes	No	Fillable Printable
Form and Instruction	0920-0932	Attachment C_Final CARE Program_ECT_Telephone Interview Guide_12 10 2014	Attachment C_Final CARE Program_ECT_Telephone Interview Guide_12 10 2014 clean.docx	Yes	No	Fillable Printable
Form and Instruction	0920-0932	Attachment F_Ebola CARE Kit_12 5 14	Attachment F_Ebola CARE Kit_12 5 14.pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Quarantine and Traveler Related Activities, Including Records for Contact Tracing Investigation and Notification under 42 CFR Parts 70 and 71	FR Citation: 72 FR 70867

Number of Respondents: 90	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	44	44
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Final CARE Program_ECT Statement A_12 10 14	Final CARE Program_ECT Statement A_12 10 14 clean.docx	12/10/2014
Final CARE Program_ECT Statement B_12 10 14	Final CARE Program_ECT Statement B_12 10 14 clean.docx	12/10/2014
Attachment B - 60 Day FRN 0920-0932	Attachment B - 60 Day FRN 0920-0932.pdf	12/10/2014
Attachment E_Determination of Applicability of Human Subjects Regulation	Attachment D_IRB Letter of Determination 12 5 14.docx	12/10/2014

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