Information Collection

Information Collection to Assess the Viajo sin Zika Awareness Communication Campaign for Hispanics/Latinos Visiting Friends and Relatives

IC 232627 under ICR 201803-0920-013 · OMB 0920-0932.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0932 Information Collection to Assess the Viajo sin Zika Awareness Communication Campaign for Hispanics/Latinos Visiting Friends and Relatives	Form and Instruction
0920-0932 Viajo sin Zika Online Focus Group Screener - English Att D - Online screener.docx	Form and Instruction
0920-0932 Viajo sin Zika Online Focus Group Screener - Spanish Att D - Online screener (Spanish).docx	Form and Instruction
0920-0932 Viajo sin Zika Online Focus Group Moderator Guide - Engl Att E - Focus Group Moderators Guide.docx	Form and Instruction
0920-0932 Viajo sin Zika Online Focus Group Moderator Guide - Span Att E - Focus Group Moderators Guide (Spanish).docx	Form and Instruction
Att A - Email invitation to partner organizations.docx Email Invitation to Partner Organizations	IC Document
Att B - Email invitation to partner organization members.docx Email Invitation to Partner Organization Members	IC Document
Att C - Recruitment Flyer.docx Recruitment Flyer - English	IC Document
Att C - Recruitment Flyer (Spanish).docx Recruitment Flyer - Spanish	IC Document
Att F - IRB Determination.pdf IRB Determination	IC Document
Viajo sin Zika_Supporting Statement A_8.9.18_FINAL.docx Supporting Statement A	IC Document
Viajo sin Zika_Supporting Statement B_8.9.18.docx Supporting Statement B	IC Document

IC Title:

Agency IC Tracking Number:

0920-0932 18AVH

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	0920-0932	Viajo sin Zika Online Focus Group Screener - English	Att D - Online screener.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0932	Viajo sin Zika Online Focus Group Screener - Spanish	Att D - Online screener (Spanish).docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0932	Viajo sin Zika Online Focus Group Moderator Guide - English	Att E - Focus Group Moderators Guide.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0932	Viajo sin Zika Online Focus Group Moderator Guide - Spanish	Att E - Focus Group Moderators Guide (Spanish).docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 216

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	216	216
Annual IC Time Burden (Hours)	84	84
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email Invitation to Partner Organizations	Att A - Email invitation to partner organizations.docx	08/15/2018
Email Invitation to Partner Organization Members	Att B - Email invitation to partner organization members.docx	08/15/2018
Recruitment Flyer - English	Att C - Recruitment Flyer.docx	08/15/2018
Recruitment Flyer - Spanish	Att C - Recruitment Flyer (Spanish).docx	08/15/2018
IRB Determination	Att F - IRB Determination.pdf	08/15/2018
Supporting Statement A	Viajo sin Zika_Supporting Statement A_8.9.18_FINAL.docx	08/15/2018
Supporting Statement B	Viajo sin Zika_Supporting Statement B_8.9.18.docx	08/15/2018

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