Community-based Mosquito Surveillance - Maternal Child Health Providers [MHPs] (NCEZID)

CDC I-Catalyst Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1158 can be found here:

Documents and Forms

Document Name Document Type
Community-based Mosquito Surveillance - Maternal Child Health Providers [MHPs] (NCEZID) Form and Instruction
Interview Guide for Material-Child Health Providers Interview Guide _Community-based Mosquito Surveillance_MHPs.docx Form and Instruction
I-Catalyst Template_Community-based Mosquito Surveillance_MHPs.docx I-Catalyst Template for MHP Project IC Document
SS-A Community-based Mosquito Surveillance_11_13 MHPs.docx Supporting Statement A IC Document

Information Collection (IC) Details

IC Title:	Community-based Mosquito Surveillance - Maternal Child Health Providers [MHPs] (NCEZID)	Agency IC Tracking Number:	0920-18FM

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	n/a	Interview Guide for Material-Child Health Providers	Interview Guide _Community-based Mosquito Surveillance_MHPs.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

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)	25	25
Annual IC Cost Burden (Dollars)	1,188	1,188

Documents for IC

Title	Document	Date Uploaded
I-Catalyst Template for MHP Project	I-Catalyst Template_Community-based Mosquito Surveillance_MHPs.docx	11/30/2017
Supporting Statement A	SS-A Community-based Mosquito Surveillance_11_13 MHPs.docx	11/30/2017

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