Information Collection

Intercept Interviews with Travelers in Puerto Rico To Test Zika Prevention Messages

IC 222248 under ICR 201502-0920-001 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Intercept Interviews with Travelers in Puerto Rico To Test Zika Prevention Messages	Form and Instruction
Intercept Interviews with Public Audiences in Puerto Ric English_Interview Questionnaire Puerto Rico_6.27.16.docx	Form and Instruction
Intercept Interviews with Public Audiences in Puerto Ric Espanol_Cuestionario Entrevistas Puertos_6.27.16.docx	Form and Instruction
5. PR non-pregnant INbound English.pdf Test Message Non-Pregnant INbound - English	IC Document
6. PR non-pregnant INbound Spanish.pdf Test Message Non-Pregnant INbound - Spanish	IC Document
16_265836_A_Heitfeld_ZikaHotelFlyers_PR_English_FINAL_508.pdf Test Message Zika Hotel Flyer - English	IC Document
16_265836_B_Heitfeld_ZikaHotelFlyers_PR_Spanish_FINAL_508.pdf Test Message Zika Hotel Flyer - Spanish	IC Document
17. PR Non-pregnant OUTbound English.pdf Test Message Non-Pregnant OUTbound - English	IC Document
18. PR non-pregnant OUTbound Spanish.pdf Test Message Non-Pregnant OUTbound - Spanish	IC Document
Combined New Eng_Span_ZIKA_FS_PR_Families(16_264014-C)_no permethrin.pdf Test Message Enjoy Your Stap in Puerto Rico - Combined English/Spanish	IC Document
HMTS Expedited review form - PR Travelers.pdf HMTS - Expedited Review Form	IC Document

IC Title:

Intercept Interviews with Travelers in Puerto Rico To Test Zika Prevention Messages

Agency IC Tracking Number:

16ATO

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	Intercept Interviews with Public Audiences in Puerto Rico To Test Zika Prevention Messages - English	English_Interview Questionnaire Puerto Rico_6.27.16.docx	NA	No		Paper Only
Form and Instruction	NA	Intercept Interviews with Public Audiences in Puerto Rico To Test Zika Prevention Messages - Spanish	Espanol_Cuestionario Entrevistas Puertos_6.27.16.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

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	60	60
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Test Message Non-Pregnant INbound - English	5. PR non-pregnant INbound English.pdf	06/29/2016
Test Message Non-Pregnant INbound - Spanish	6. PR non-pregnant INbound Spanish.pdf	06/29/2016
Test Message Zika Hotel Flyer - English	16_265836_A_Heitfeld_ZikaHotelFlyers_PR_English_FINAL_508.pdf	06/29/2016
Test Message Zika Hotel Flyer - Spanish	16_265836_B_Heitfeld_ZikaHotelFlyers_PR_Spanish_FINAL_508.pdf	06/29/2016
Test Message Non-Pregnant OUTbound - English	17. PR Non-pregnant OUTbound English.pdf	06/29/2016
Test Message Non-Pregnant OUTbound - Spanish	18. PR non-pregnant OUTbound Spanish.pdf	06/29/2016
Test Message Enjoy Your Stap in Puerto Rico - Combined English/Spanish	Combined New Eng_Span_ZIKA_FS_PR_Families(16_264014-C)_no permethrin.pdf	06/29/2016
HMTS - Expedited Review Form	HMTS Expedited review form - PR Travelers.pdf	06/29/2016

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