Information Collection

Emerging mosquito-borne diseases: assessment of chikungunya and dengue-related knowledge, attitudes and practices for Mexican-origin audiences along the U.S-Mexico border

IC 217878 under ICR 201308-0920-007 · OMB 0920-0987.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0987 can be found here:

Documents and Forms

Document Name Document Type
Emerging mosquito-borne diseases: assessment of chikungunya and dengue-related knowledge, attitudes and practices for Mexican-origin audiences along the U.S-Mexico border Form and Instruction
Participant Screener Attachment J Participant Screener 83 15 rev.docx Form and Instruction
Focus Group Discussion Guide Attachment I Focus Group Discussion Guide 0803 15.docx Form and Instruction
0920-0987 Chik Supporting Statement A - 08132015.docx Supporting Statement A IC Document
0920-0987 Chik Supporting Statement B - 08032015.docx Supporting Statement B IC Document
Attachment A 42 USC § 264.pdf Public Health Service Act IC Document
Attachment C 42 CFR 70.pdf 42 CFR 70 IC Document
Attachment D 42 CFR 71.pdf 42 CFR 71 IC Document
Attachment E 8 USC § 1182(a)(1)(A).pdf 8 USC 1182(a)(1)(A) IC Document
Attachment F 42 USC § 252.pdf 42 USC 252 IC Document
Attachment G 42 CFR 34.pdf 42 CFR 34 IC Document
Attachment H Section 301 of the Public Health Service Act (42 USC 241).pdf Section 301 of PHSA IC Document
Attachment K Participant Information Sheet 7.1.15.docx Participant Information Sheet IC Document
Attachment L Chikungunya and Dengue Messages.docx Chikungunya and Dengue Messages IC Document
Attachment M Infographic materials_English and Spanish_FINAL.docx Infographic Materials English/Spanish IC Document
Attachment O IRB Non-Research Determination.pdf IRB Research Determination IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Emerging mosquito-borne diseases: assessment of chikungunya and dengue-related knowledge, attitudes and practices for Mexican-origin audiences along the U.S-Mexico border	Agency IC Tracking Number:	15BBA

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	NA	Participant Screener	Attachment J Participant Screener 83 15 rev.docx	NA	No		Paper Only
Form and Instruction	NA	Focus Group Discussion Guide	Attachment I Focus Group Discussion Guide 0803 15.docx	None	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 360	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	360	360
Annual IC Time Burden (Hours)	280	280
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	0920-0987 Chik Supporting Statement A - 08132015.docx	08/13/2015
Supporting Statement B	0920-0987 Chik Supporting Statement B - 08032015.docx	08/13/2015
Public Health Service Act	Attachment A 42 USC Â§ 264.pdf	08/13/2015
42 CFR 70	Attachment C 42 CFR 70.pdf	08/13/2015
42 CFR 71	Attachment D 42 CFR 71.pdf	08/13/2015
8 USC 1182(a)(1)(A)	Attachment E 8 USC Â§ 1182(a)(1)(A).pdf	08/13/2015
42 USC 252	Attachment F 42 USC Â§ 252.pdf	08/13/2015
42 CFR 34	Attachment G 42 CFR 34.pdf	08/13/2015
Section 301 of PHSA	Attachment H Section 301 of the Public Health Service Act (42 USC 241).pdf	08/13/2015
Participant Information Sheet	Attachment K Participant Information Sheet 7.1.15.docx	08/13/2015
Chikungunya and Dengue Messages	Attachment L Chikungunya and Dengue Messages.docx	08/13/2015
Infographic Materials English/Spanish	Attachment M Infographic materials_English and Spanish_FINAL.docx	08/13/2015
IRB Research Determination	Attachment O IRB Non-Research Determination.pdf	08/13/2015

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