CDC Zika Website

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⚠️ Notice: This information collection may be referencing outdated material.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 0920-1050 can be found here:

Documents and Forms

Document Name Document Type
CDC Zika Website Form and Instruction
CDC Zika website User Experience (UX): Questionnaire D-Questionnaire - OMB.docx Form and Instruction
ZIKA USABILITY TEST: NOTETAKING DOCUMENT H-Usability Test Plan_Notetaking Doc.docx Form and Instruction
A-Protocal -CDC_ZikaWeb_UX_06_24_16-OMB.docx CDC Zika Website Protocol 06SEP2016 IC Document
B-ConsentForm_Zika_UX.docx CDC Zika Website Consent Form 06SEP2016 IC Document
C-Instructions -CDCZikaUX - OMB.docx CDC Zika Website Facilitator Introduction/Instructions 06SEP2016 IC Document
E-Participant Scenarios_Men.docx CDC Zika Website Participant Scenarios - Men 06SEP2016 IC Document
F-Participant Scenarios_Women.docx CDC Zika Website Participant Scenarios - Women 06SEP2016 IC Document
G-Participant Scenarios_For specific Audiences.docx CDC Zika Website Participant Scenarios - HealthCare Providers 06SEP2016 IC Document
K - Zika Website Screenshots.docx CDC Zika Website Screenshots 06SEP2016 IC Document
List of Attachments-CDCZikaUX0616 (002).docx List of Attachments 06SEP2016 IC Document
J-fast-track-PRA-submission-short-form-cdc_zika_Usability Protocol.docx Fast Track GenIC Request IC Document

Information Collection (IC) Details

IC Title:	CDC Zika Website	Agency IC Tracking Number:	16ATN

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 and Instruction	NA	ZIKA USABILITY TEST: NOTETAKING DOCUMENT	H-Usability Test Plan_Notetaking Doc.docx	NA	Yes	Yes	Paper Only
Form and Instruction	NA	CDC Zika website User Experience (UX): Questionnaire	D-Questionnaire - OMB.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	50	50
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CDC Zika Website Protocol 06SEP2016	A-Protocal -CDC_ZikaWeb_UX_06_24_16-OMB.docx	09/06/2016
CDC Zika Website Consent Form 06SEP2016	B-ConsentForm_Zika_UX.docx	09/06/2016
CDC Zika Website Facilitator Introduction/Instructions 06SEP2016	C-Instructions -CDCZikaUX - OMB.docx	09/06/2016
CDC Zika Website Participant Scenarios - Men 06SEP2016	E-Participant Scenarios_Men.docx	09/06/2016
CDC Zika Website Participant Scenarios - Women 06SEP2016	F-Participant Scenarios_Women.docx	09/06/2016
CDC Zika Website Participant Scenarios - HealthCare Providers 06SEP2016	G-Participant Scenarios_For specific Audiences.docx	09/06/2016
CDC Zika Website Screenshots 06SEP2016	K - Zika Website Screenshots.docx	09/06/2016
List of Attachments 06SEP2016	List of Attachments-CDCZikaUX0616 (002).docx	09/06/2016
Fast Track GenIC Request	J-fast-track-PRA-submission-short-form-cdc_zika_Usability Protocol.docx	09/08/2016

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