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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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:

table that charts list of 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

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	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

table that charts IC Documents
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.