Information Collection

Mosquito Bite Prevention Kit Feedback

IC 226830 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⚠️ Notice: This information collection may be referencing outdated material.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
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

IC Title:

Mosquito Bite Prevention Kit Feedback

Agency IC Tracking Number:

17AHY

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.