Evaluating the Effectiveness of Ebola CARE Plus 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⚠️ Notice: This information collection may be referencing outdated material.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
Evaluating the Effectiveness of Ebola CARE Plus Program Form and Instruction
In-person survey of traveler intercepted at the airport Attachment A In person survey at airport_Responses to OMBcomments.clean.docx Form and Instruction
Telephone survey within 3-5 days after airport survey Attachment B Telephone Survey within 3-5 days of airport survey AR 03 03 15.docx Form and Instruction
Telephone Survey 2 Days before Last Scheduled Day To Rep Attachment C Telephone Survey 2 days before reporting end date AR 03 03 15.docx Form and Instruction
Data Request to Health Departments Attachment D Data request to health departments _Response to OMBcomments.clean.docx Form and Instruction
Cultural Sensitivity Assessment Tool Attachment E Cultural Competency Assessment Tool Responses to OMBcomments.clean.docx Form and Instruction
Statement A 02APR2015_Responses to OMBcomments.clean.docx Supporting Statement A IC Document
Statement B 02APR2015_Response to OMBcomments.clean.docx Supporting Statement B IC Document
Attachment F Ebola CARE Kit.pdf Ebola CARE Kit - Review Material IC Document
Attachment H.Letter of Determination.pdf Research Determination Letter IC Document

Information Collection (IC) Details

IC Title:	Evaluating the Effectiveness of Ebola CARE Plus Program	Agency IC Tracking Number:	0920-0932

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	In-person survey of traveler intercepted at the airport	Attachment A In person survey at airport_Responses to OMBcomments.clean.docx	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Telephone survey within 3-5 days after airport survey	Attachment B Telephone Survey within 3-5 days of airport survey AR 03 03 15.docx	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Telephone Survey 2 Days before Last Scheduled Day To Report to Health Department	Attachment C Telephone Survey 2 days before reporting end date AR 03 03 15.docx	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Data Request to Health Departments	Attachment D Data request to health departments _Response to OMBcomments.clean.docx	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Cultural Sensitivity Assessment Tool	Attachment E Cultural Competency Assessment Tool Responses to OMBcomments.clean.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09200171 - Quarantine and Traveler Related Activities	FR Citation: 72 FR 70867

Number of Respondents: 3,008	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,008	3,008
Annual IC Time Burden (Hours)	1,239	1,239
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	Statement A 02APR2015_Responses to OMBcomments.clean.docx	04/02/2015
Supporting Statement B	Statement B 02APR2015_Response to OMBcomments.clean.docx	04/02/2015
Ebola CARE Kit - Review Material	Attachment F Ebola CARE Kit.pdf	04/02/2015
Research Determination Letter	Attachment H.Letter of Determination.pdf	04/02/2015

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