Information Collection

[NCEZID] In-depth Interviews with Hispanic or Latina Women on the Topic of Climate Change and Infectious Diseases

IC 261557 under ICR 202503-0920-028 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1154 [NCEZID] In-depth Interviews with Hispanic or Latina Women on the Topic of Climate Change and Infectious Diseases	Form and Instruction
Form 0920-1154 RECRUITMENT SCREENER In-Depth Interviews with Hispanic or Latina Women [NCEZID] In-depth Interviews with Hispanic or Latina Women on the Topic of Climate Change and Infectious Diseases	Form and Instruction
Form 0920-1154 CONSENT FORM In-Depth Interviews with Hispanic or Latina Women [NCEZID] In-depth Interviews with Hispanic or Latina Women on the Topic of Climate Change and Infectious Diseases	Form
Form 0920-1154 MODERATOR INTERVIEW GUIDE In-Depth Interviews with Hispanic or Latina Women [NCEZID] In-depth Interviews with Hispanic or Latina Women on the Topic of Climate Change and Infectious Diseases	Form and Instruction
0920-1154 RECRUITMENT SCREENER In-Depth Interviews with Hispanic o Attachment 1 - Screener.docx	Form and Instruction
0920-1154 RECRUITMENT SCREENER In-Depth Interviews with Hispanic o Attachment 1 - Screener.docx	Form and Instruction
0920-1154 CONSENT FORM In-Depth Interviews with Hispanic or Latina Attachment 2 - Consent Form.docx	Form
0920-1154 CONSENT FORM In-Depth Interviews with Hispanic or Latina Attachment 2 - Consent Form.docx	Form
0920-1154 MODERATOR INTERVIEW GUIDE In-Depth Interviews with Hispa Attachment 3 - Interview Guide.docx	Form and Instruction
0920-1154 MODERATOR INTERVIEW GUIDE In-Depth Interviews with Hispa Attachment 3 - Interview Guide.docx	Form and Instruction
GenIC Request Form - 081423.docx Request for Approval under the “Generic Clearance (OMB Control Number: 0920-1154)	IC Document
GenIC Request Form - 081423.docx Request for Approval under the “Generic Clearance (OMB Control Number: 0920-1154)	IC Document
Attachment 4 - Human Subjects Determination.pdf Human Subjects Determination	IC Document
Attachment 4 - Human Subjects Determination.pdf Human Subjects Determination	IC Document
Supporting Statement A - 8-10-23.docx SSA	IC Document
Supporting Statement A - 8-10-23.docx SSA	IC Document
Supporting Statement B - 8-10-23.docx SSB	IC Document
Supporting Statement B - 8-10-23.docx SSB	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[NCEZID] In-depth Interviews with Hispanic or Latina Women on the Topic of Climate Change and Infectious Diseases

Agency IC Tracking Number:

0920-1154-23HR

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1154	Yes	Yes	Fillable Fileable
Form	0920-1154	Yes	Yes	Fillable Fileable Signable
Form and Instruction	0920-1154	Yes	Yes	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: 90

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval under the âGeneric Clearance (OMB Control Number: 0920-1154)		08/14/2023
Human Subjects Determination		08/14/2023
SSA		08/14/2023
SSB		08/14/2023

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

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