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

Data Collection for Evaluation of Education, Communication, and Training Activities

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Attachment C Word of Mouth Survey.docx		Yes	Yes	Fillable Fileable

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 %

	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

Title	Document	Date Uploaded
Att C1_ENCUESTA SOBRE LA INFORMACION RECIBIDA DE PERSONA A PERSONA	Attachment C1 Word of Mouth Survey_SPANISH_12.11.17.docx	12/20/2017
Supporting Statement A	Supporting Statement A 0920-0932 Zika VFR.DOCX	12/20/2017
Supporting Statement B	Supporting Statement B 0920-0932 Zika VFR.DOCX	12/20/2017
Att A_ Informed Consent Statement for Print Survey	Attachment A Word of Mouth Consent Paper.docx	12/20/2017
Att A1_INFORMED CONSENT STATEMENT (PRINTED SPANISH VERSION)	Attachment A1 Word of Mouth Consent Paper_SPANISH_12.11.17.docx	12/20/2017
Att B_Informed Consent Statement for Online Survey	Attachment B Word of Mouth Consent Online.docx	12/20/2017
Att B1_INFORMED CONSENT STATEMENT (ONLINE SPANISH VERSION)	Attachment B1 Word of Mouth Consent Online_SPANISH_12.11.17.docx	12/20/2017
Att D_DETERMINATION OF NON-APPLICABILITY OF HUMAN SUBJECT REGULATIONS	Attachment D CDC Human Subjects Determination Documentation.pdf	12/20/2017

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