Information Collection

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

IC 261557 under ICR 202507-0920-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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 [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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1154	RECRUITMENT SCREENER In-Depth Interviews with Hispanic or Latina Women	Attachment 1 - Screener.docx	Yes	Yes	Fillable Fileable
Form	0920-1154	CONSENT FORM In-Depth Interviews with Hispanic or Latina Women	Attachment 2 - Consent Form.docx	Yes	Yes	Fillable Fileable Signable
Form and Instruction	0920-1154	MODERATOR INTERVIEW GUIDE In-Depth Interviews with Hispanic or Latina Women	Attachment 3 - Interview Guide.docx	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 %

	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

Title	Document	Date Uploaded
Request for Approval under the âGeneric Clearance (OMB Control Number: 0920-1154)	GenIC Request Form - 081423.docx	08/14/2023
Human Subjects Determination	Attachment 4 - Human Subjects Determination.pdf	08/14/2023
SSA	Supporting Statement A - 8-10-23.docx	08/14/2023
SSB	Supporting Statement B - 8-10-23.docx	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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