Document Name Document Type
Domestic Readiness Initiative on Zika Virus Disease: Year 2 Message & Materials Testing Form and Instruction
Community Leader - Focus Group Screening Instrument Att2_CommLeadr_Screener_FG__final.docx Form and Instruction
Men/Women Reproductive Age (18-49) - Focus Group Screeni Att3_Men_Women Screener_FG_finaL.docx Form and Instruction
Community Leader - Focus Group Guide Att4_CommLeadr Focus Group Guide_final.docx Form and Instruction
Men/Women Reproductive Age (18-49) - Focus Group Guide Att5_Men_Women Focus Group Guide_final.docx Form and Instruction
Att6A_How to Protect Against Mosquito Bites.pdf How to Protect Against Mosquito Bites - English IC Document
Att6B_How to Protect Against Mosquito Bites_SPANISH.pdf How to Protect Against Mosquito Bites - Spanish IC Document
Att6C_Mosquito Control Promote the Partnership in Your Community.pdf Mosquito Control - Promote the Partnership in Your Community - English IC Document
Att6D_Mosquito Control Promote the Partnership in Your Community_SPANISH.PDF Mosquito Control - Promote the Partnership in Your Community - Spanish IC Document
Att6E_Protect Your Family and Community- How Zika Spreads.pdf Protect Your Family and Community- How Zika Spreads - English IC Document
Att6F_Protect Your Family and Community- How Zika Spreads_SPANISH.pdf Protect Your Family and Community- How Zika Spreads - Spanish IC Document
Att7A_ Protect Your Family and Community- How Zika Spreads.pdf Protect Your Family and Community- How Zika Spreads - English IC Document
Att7B_Protect Your Family and Community- How Zika Spreads_SPANISH.pdf Protect Your Family and Community- How Zika Sprea - Spanish IC Document
Att7C_Why We Are All Responsible- No Text.pdf Why We Are All Responsible for Zika Prevention - No Text English IC Document
Att7D_Why We Are All Responsible for Zika Prevention-No Text SPANISH.pdf Why We Are All Responsible for Zika Prevention - No Text Spanish IC Document
Att7E_Why We Are All Responsible for Zika Prevention-With Text.pdf Why We Are All Responsible for Zika Prevention - With Text English IC Document
Att7F_Why We Are All Responsible for Zika Prevention-With Text_SPANISH.pdf Why We Are All Responsible for Zika Prevention - With Text Spanish IC Document
Att7G_Picking and Using an Insect Repellent.pdf Picking and Using an Insect Repellent - English IC Document
Att7H_Picking and Using an Insect Repellent_SPANISH.pdf Picking and Using an Insect Repellent - Spanish IC Document
Att8_OADC Research_non-research Determination_task10_Zika(f).docx Non-Research Determination IC Document
Att9_List of attachments_final.docx List of Attachments IC Document
HMTSExpeditedReviewForm_T10-final.pdf 0920-0572 - HMTS Request IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Domestic Readiness Initiative on Zika Virus Disease: Year 2 Message & Materials Testing	Agency IC Tracking Number:	0920-0572-17AUY

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Electronic Capability
Form and Instruction	NA	Community Leader - Focus Group Screening Instrument	Att2_CommLeadr_Screener_FG__final.docx	NA	No	Paper Only
Form and Instruction	NA	Men/Women Reproductive Age (18-49) - Focus Group Screening Instrument	Att3_Men_Women Screener_FG_finaL.docx	NA	No	Paper Only
Form and Instruction	NA	Community Leader - Focus Group Guide	Att4_CommLeadr Focus Group Guide_final.docx	NA	No	Paper Only
Form and Instruction	NA	Men/Women Reproductive Age (18-49) - Focus Group Guide	Att5_Men_Women Focus Group Guide_final.docx	NA	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: 125	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	125	125
Annual IC Time Burden (Hours)	73	73
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
How to Protect Against Mosquito Bites - English	Att6A_How to Protect Against Mosquito Bites.pdf	07/27/2017
How to Protect Against Mosquito Bites - Spanish	Att6B_How to Protect Against Mosquito Bites_SPANISH.pdf	07/27/2017
Mosquito Control - Promote the Partnership in Your Community - English	Att6C_Mosquito Control Promote the Partnership in Your Community.pdf	07/27/2017
Mosquito Control - Promote the Partnership in Your Community - Spanish	Att6D_Mosquito Control Promote the Partnership in Your Community_SPANISH.PDF	07/27/2017
Protect Your Family and Community- How Zika Spreads - English	Att6E_Protect Your Family and Community- How Zika Spreads.pdf	07/27/2017
Protect Your Family and Community- How Zika Spreads - Spanish	Att6F_Protect Your Family and Community- How Zika Spreads_SPANISH.pdf	07/27/2017
Protect Your Family and Community- How Zika Spreads - English	Att7A_ Protect Your Family and Community- How Zika Spreads.pdf	07/27/2017
Protect Your Family and Community- How Zika Sprea - Spanish	Att7B_Protect Your Family and Community- How Zika Spreads_SPANISH.pdf	07/27/2017
Why We Are All Responsible for Zika Prevention - No Text English	Att7C_Why We Are All Responsible- No Text.pdf	07/27/2017
Why We Are All Responsible for Zika Prevention - No Text Spanish	Att7D_Why We Are All Responsible for Zika Prevention-No Text SPANISH.pdf	07/27/2017
Why We Are All Responsible for Zika Prevention - With Text English	Att7E_Why We Are All Responsible for Zika Prevention-With Text.pdf	07/27/2017
Why We Are All Responsible for Zika Prevention - With Text Spanish	Att7F_Why We Are All Responsible for Zika Prevention-With Text_SPANISH.pdf	07/27/2017
Picking and Using an Insect Repellent - English	Att7G_Picking and Using an Insect Repellent.pdf	07/27/2017
Picking and Using an Insect Repellent - Spanish	Att7H_Picking and Using an Insect Repellent_SPANISH.pdf	07/27/2017
Non-Research Determination	Att8_OADC Research_non-research Determination_task10_Zika(f).docx	07/27/2017
List of Attachments	Att9_List of attachments_final.docx	07/27/2017
0920-0572 - HMTS Request	HMTSExpeditedReviewForm_T10-final.pdf	07/27/2017

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

Domestic Readiness Initiative on Zika Virus Disease: Year 2 Message & Materials Testing

CDC and ATSDR Health Message Testing System

OMB: 0920-0572

IC ID: 227732

View Information Collection (IC)