Information Collection

[PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024)

IC 269705 under ICR 202410-0920-015 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

2026-08-07 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0879 [PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024)	Form
Form 0920-0879 MAHC Use and Acceptability Survey (EpiInfo Web Survey) [PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024)	Form
Form 0920-0879 Focus Group Discussion Guide—Moderate MAHC Use and Implementation [PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024)	Form and Instruction
Form 0920-0879 Focus Group Discussion Guide—Moderate MAHC Use and Implementation [PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024)	Form and Instruction
Form 0920-0879 Focus Group Discussion Guide—Advanced MAHC Use and Implementation [PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024)	Form and Instruction
Form 0920-0879 Case Study In-Depth Interview Guide [PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024)	Form and Instruction
0920-0879 MAHC Use and Acceptability Survey (EpiInfo Web Survey) AttB_MAHC_UA_SurveyV2.pdf epiinfosecurewebsurvey.cdc.gov/Survey/6efb7a91-f9b2-48c0-9013-cc370b2d6b65/1	Form
0920-0879 MAHC Use and Acceptability Survey (EpiInfo Web Survey) AttB_MAHC_UA_SurveyV2.pdf epiinfosecurewebsurvey.cdc.gov/Survey/6efb7a91-f9b2-48c0-9013-cc370b2d6b65/1	Form
0920-0879 Focus Group Discussion Guide—Moderate MAHC Use and Imple AttD1_FGGuide_Lim.pdf	Form and Instruction
0920-0879 Focus Group Discussion Guide—Moderate MAHC Use and Imple AttD1_FGGuide_Lim.pdf	Form and Instruction
0920-0879 Focus Group Discussion Guide—Moderate MAHC Use and Imple AttD2_FGGuide_Mod.pdf	Form and Instruction
0920-0879 Focus Group Discussion Guide—Moderate MAHC Use and Imple AttD2_FGGuide_Mod.pdf	Form and Instruction
0920-0879 Focus Group Discussion Guide—Advanced MAHC Use and Imple AttD3_FGGuide_Adv.pdf	Form and Instruction
0920-0879 Focus Group Discussion Guide—Advanced MAHC Use and Imple AttD3_FGGuide_Adv.pdf	Form and Instruction
0920-0879 Case Study In-Depth Interview Guide AttE_CS_IDIGuide.pdf	Form and Instruction
0920-0879 Case Study In-Depth Interview Guide AttE_CS_IDIGuide.pdf	Form and Instruction
MAHC_SSA_07232024_clean.docx SSA	IC Document
MAHC_SSA_07232024_clean.docx SSA	IC Document
MAHC_SSB_07232024_clean.docx SSB	IC Document
MAHC_SSB_07232024_clean.docx SSB	IC Document
AttC_FocusGroupPlacement.pdf Algorithm for Focus Group Placement	IC Document
AttC_FocusGroupPlacement.pdf Algorithm for Focus Group Placement	IC Document
AttF_CS_SurveyConsentForm.pdf Survey Consent Form	IC Document
AttF_CS_SurveyConsentForm.pdf Survey Consent Form	IC Document
AttG1_SurveyRecEmail.pdf Survey Recruitment Email	IC Document
AttG1_SurveyRecEmail.pdf Survey Recruitment Email	IC Document
AttG2_SurveyRec_PtListserv.pdf Survey Recruitment: Partner Listserv Email	IC Document
AttG2_SurveyRec_PtListserv.pdf Survey Recruitment: Partner Listserv Email	IC Document
AttG3_SurveyRemEmail.pdf Survey Reminder Email	IC Document
AttG3_SurveyRemEmail.pdf Survey Reminder Email	IC Document
AttH_SnSamRecEmail.pdf Survey Snowball Sampling Recruitment Email	IC Document
AttH_SnSamRecEmail.pdf Survey Snowball Sampling Recruitment Email	IC Document
AttI1_FGInvEmail.pdf Focus Group Invitation Email	IC Document
AttI1_FGInvEmail.pdf Focus Group Invitation Email	IC Document
AttI2_FGConfirmationEmail.pdf Focus Group Confirmation Email	IC Document
AttI2_FGConfirmationEmail.pdf Focus Group Confirmation Email	IC Document
AttI3_FGReminderEmail.pdf Focus Group Reminder Email	IC Document
AttI3_FGReminderEmail.pdf Focus Group Reminder Email	IC Document
AttJ_FGConsent.pdf Focus Group Consent Form	IC Document
AttJ_FGConsent.pdf Focus Group Consent Form	IC Document
AttK1_CSRecEmail.pdf Case Study Recruitment Email	IC Document
AttK1_CSRecEmail.pdf Case Study Recruitment Email	IC Document
AttK2_CSConfEmail.pdf Case Study Confirmation Email	IC Document
AttK2_CSConfEmail.pdf Case Study Confirmation Email	IC Document
AttL_CSConsent.pdf Case Study Consent Form	IC Document
AttL_CSConsent.pdf Case Study Consent Form	IC Document
MAHC_STARS_03072024.pdf Determination of Non-applicability of Human Subjects Regulations	IC Document
MAHC_STARS_03072024.pdf Determination of Non-applicability of Human Subjects Regulations	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024)

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-0879	https://epiinfosecurewebsurvey.cdc.gov/Survey/6efb7a91-f9b2-48c0-9013-cc370b2d6b65/1	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0879		Yes	No	Fillable Fileable
Form and Instruction	0920-0879		Yes	No	Fillable Fileable
Form and Instruction	0920-0879		Yes	No	Fillable Fileable
Form and Instruction	0920-0879		Yes	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,373

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1,373	1,373
Annual IC Time Burden (Hours)	706	706
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA		07/31/2024
SSB		07/31/2024
Algorithm for Focus Group Placement		07/31/2024
Survey Consent Form		07/31/2024
Survey Recruitment Email		07/31/2024
Survey Recruitment: Partner Listserv Email		07/31/2024
Survey Reminder Email		07/31/2024
Survey Snowball Sampling Recruitment Email		07/31/2024
Focus Group Invitation Email		07/31/2024
Focus Group Confirmation Email		07/31/2024
Focus Group Reminder Email		07/31/2024
Focus Group Consent Form		07/31/2024
Case Study Recruitment Email		07/31/2024
Case Study Confirmation Email		07/31/2024
Case Study Consent Form		07/31/2024
Determination of Non-applicability of Human Subjects Regulations		07/31/2024

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

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