Information Collection

Evaluation of Travelers' Health Zika Prevention Communication Campaign for HispanicsLatinos Visiting Friends and Family Word of Mouth Survey (Pre/Post Test)

IC 229522 under ICR 201503-0920-002 · OMB 0920-0932.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0932 can be found here:

2018-04-10 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment C Word of Mouth Survey.docx	Other-WORD
Attachment C1 Word of Mouth Survey_SPANISH_12.11.17.docx Att C1_ENCUESTA SOBRE LA INFORMACION RECIBIDA DE PERSONA A PERSONA	IC Document
Supporting Statement A 0920-0932 Zika VFR.DOCX Supporting Statement A	IC Document
Supporting Statement B 0920-0932 Zika VFR.DOCX Supporting Statement B	IC Document
Attachment A Word of Mouth Consent Paper.docx Att A_ Informed Consent Statement for Print Survey	IC Document
Attachment A1 Word of Mouth Consent Paper_SPANISH_12.11.17.docx Att A1_INFORMED CONSENT STATEMENT (PRINTED SPANISH VERSION)	IC Document
Attachment B Word of Mouth Consent Online.docx Att B_Informed Consent Statement for Online Survey	IC Document
Attachment B1 Word of Mouth Consent Online_SPANISH_12.11.17.docx Att B1_INFORMED CONSENT STATEMENT (ONLINE SPANISH VERSION)	IC Document
Attachment D CDC Human Subjects Determination Documentation.pdf Att D_DETERMINATION OF NON-APPLICABILITY OF HUMAN SUBJECT REGULATIONS	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Evaluation of Travelers' Health Zika Prevention Communication Campaign for HispanicsLatinos Visiting Friends and Family Word of Mouth Survey (Pre/Post Test)

Agency IC Tracking Number:

0920-18JU

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
Other-WORD					Yes	Yes	Fillable Fileable

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: 800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	132	132
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att C1_ENCUESTA SOBRE LA INFORMACION RECIBIDA DE PERSONA A PERSONA		12/20/2017
Supporting Statement A		12/20/2017
Supporting Statement B		12/20/2017
Att A_ Informed Consent Statement for Print Survey		12/20/2017
Att A1_INFORMED CONSENT STATEMENT (PRINTED SPANISH VERSION)		12/20/2017
Att B_Informed Consent Statement for Online Survey		12/20/2017
Att B1_INFORMED CONSENT STATEMENT (ONLINE SPANISH VERSION)		12/20/2017
Att D_DETERMINATION OF NON-APPLICABILITY OF HUMAN SUBJECT REGULATIONS		12/20/2017

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

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