Information Collection

Formative Evaluation of CDC Autocidal Gravid Traps in Puerto Rico

IC 221551 under ICR 201503-0920-011 · OMB 0920-1071.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1071 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Formative Evaluation of CDC Autocidal Gravid Traps in Puerto Rico	Form and Instruction
Focus Group Discussion Guide CDC-AGO Puerto Rico Focus Group Discussion Guide and informed consent in Puerto Rico May 15.docx	Form and Instruction
0920-1071 Traps in PR.docx GenIC Request	IC Document
Traps in PR NRD.pdf Non-Research Determination	IC Document

IC Title:

Formative Evaluation of CDC Autocidal Gravid Traps in Puerto Rico

Agency IC Tracking Number:

16ALO

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	Focus Group Discussion Guide CDC-AGO Puerto Rico	Focus Group Discussion Guide and informed consent in Puerto Rico May 15.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

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)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request	0920-1071 Traps in PR.docx	05/17/2016
Non-Research Determination	Traps in PR NRD.pdf	05/17/2016

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