Mosquito Bite Prevention Kit Feedback

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Mosquito Bite Prevention Kit Feedback Form
Mosquito Prevention Kit Feedback - English Att. 1 - MPK Feedback Postcard - ENGLISH.pdf Form
Mosquito Prevention Kit Feedback - Spanish Att. 1 - MPK Feedback Postcard - SPANISH.pdf Form
Service Delivery Fast Track Template_MPK 2017.docx Request for Approval IC Document
Att. 2 - IRB Determination.pdf IRB Determination IC Document

Information Collection (IC) Details

IC Title:	Mosquito Bite Prevention Kit Feedback	Agency IC Tracking Number:	17AHY

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
Form	none	Mosquito Prevention Kit Feedback - English	Att. 1 - MPK Feedback Postcard - ENGLISH.pdf		No		Paper Only
Form	none	Mosquito Prevention Kit Feedback - Spanish	Att. 1 - MPK Feedback Postcard - SPANISH.pdf		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,000	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	14,000	14,000
Annual IC Time Burden (Hours)	1,633	1,633
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Service Delivery Fast Track Template_MPK 2017.docx	05/15/2017
IRB Determination	Att. 2 - IRB Determination.pdf	05/15/2017

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