Information Collection

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

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

Documents and Forms

Document Name Document Type
Form 0920-0879 [PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024) Form
Form 0920-0879 [PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024) 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 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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-0879	MAHC Use and Acceptability Survey (EpiInfo Web Survey)	AttB_MAHC_UA_SurveyV2.pdf	https://epiinfosecurewebsurvey.cdc.gov/Survey/6efb7a91-f9b2-48c0-9013-cc370b2d6b65/1	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0879	Focus Group Discussion GuideâModerate MAHC Use and Implementation	AttD1_FGGuide_Lim.pdf		Yes	No	Fillable Fileable
Form and Instruction	0920-0879	Focus Group Discussion GuideâModerate MAHC Use and Implementation	AttD2_FGGuide_Mod.pdf		Yes	No	Fillable Fileable
Form and Instruction	0920-0879	Focus Group Discussion GuideâAdvanced MAHC Use and Implementation	AttD3_FGGuide_Adv.pdf		Yes	No	Fillable Fileable
Form and Instruction	0920-0879	Case Study In-Depth Interview Guide	AttE_CS_IDIGuide.pdf		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 %

	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

Title	Document	Date Uploaded
SSA	MAHC_SSA_07232024_clean.docx	07/31/2024
SSB	MAHC_SSB_07232024_clean.docx	07/31/2024
Algorithm for Focus Group Placement	AttC_FocusGroupPlacement.pdf	07/31/2024
Survey Consent Form	AttF_CS_SurveyConsentForm.pdf	07/31/2024
Survey Recruitment Email	AttG1_SurveyRecEmail.pdf	07/31/2024
Survey Recruitment: Partner Listserv Email	AttG2_SurveyRec_PtListserv.pdf	07/31/2024
Survey Reminder Email	AttG3_SurveyRemEmail.pdf	07/31/2024
Survey Snowball Sampling Recruitment Email	AttH_SnSamRecEmail.pdf	07/31/2024
Focus Group Invitation Email	AttI1_FGInvEmail.pdf	07/31/2024
Focus Group Confirmation Email	AttI2_FGConfirmationEmail.pdf	07/31/2024
Focus Group Reminder Email	AttI3_FGReminderEmail.pdf	07/31/2024
Focus Group Consent Form	AttJ_FGConsent.pdf	07/31/2024
Case Study Recruitment Email	AttK1_CSRecEmail.pdf	07/31/2024
Case Study Confirmation Email	AttK2_CSConfEmail.pdf	07/31/2024
Case Study Consent Form	AttL_CSConsent.pdf	07/31/2024
Determination of Non-applicability of Human Subjects Regulations	MAHC_STARS_03072024.pdf	07/31/2024

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