Information Collection

Evaluating the Effectiveness of Ebola CARE Program

IC 214209 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.