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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Evaluating the Effectiveness of Ebola CARE Program
Agency IC Tracking Number:
15GZ
IC Status:
New
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 and Instruction
0920-0932
Attachment A_Final CARE Program_ECT_Intercept Interview Guide_12 10 14
Attachment A_Final CARE Program_ECT_Intercept Interview Guide_12 10 14 clean.docx
Yes
No
Fillable Printable
Form and Instruction
0920-0932
Attachment C_Final CARE Program_ECT_Telephone Interview Guide_12 10 2014
Attachment C_Final CARE Program_ECT_Telephone Interview Guide_12 10 2014 clean.docx
Yes
No
Fillable Printable
Form and Instruction
0920-0932
Attachment F_Ebola CARE Kit_12 5 14
Attachment F_Ebola CARE Kit_12 5 14.pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Quarantine and Traveler Related Activities, Including Records for Contact Tracing Investigation and Notification under 42 CFR Parts 70 and 71
FR Citation:
72 FR 70867
Number of Respondents:
90
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
90
0
90
0
0
0
Annual IC Time Burden (Hours)
44
0
44
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Final CARE Program_ECT Statement A_12 10 14
Final CARE Program_ECT Statement A_12 10 14 clean.docx
12/10/2014
Final CARE Program_ECT Statement B_12 10 14
Final CARE Program_ECT Statement B_12 10 14 clean.docx
12/10/2014
Attachment B - 60 Day FRN 0920-0932
Attachment B - 60 Day FRN 0920-0932.pdf
12/10/2014
Attachment E_Determination of Applicability of Human Subjects Regulation
Attachment D_IRB Letter of Determination 12 5 14.docx
12/10/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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