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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Emerging mosquito-borne diseases: assessment of chikungunya and dengue-related knowledge, attitudes and practices for Mexican-origin audiences along the U.S-Mexico border
Agency IC Tracking Number:
15BBA
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
NA
Participant Screener
Attachment J Participant Screener 83 15 rev.docx
NA
No
Paper Only
Form and Instruction
NA
Focus Group Discussion Guide
Attachment I Focus Group Discussion Guide 0803 15.docx
None
No
Paper Only
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:
360
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
360
0
360
0
0
0
Annual IC Time Burden (Hours)
280
0
280
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement A
0920-0987 Chik Supporting Statement A - 08132015.docx
08/13/2015
Supporting Statement B
0920-0987 Chik Supporting Statement B - 08032015.docx
08/13/2015
Public Health Service Act
Attachment A 42 USC § 264.pdf
08/13/2015
42 CFR 70
Attachment C 42 CFR 70.pdf
08/13/2015
42 CFR 71
Attachment D 42 CFR 71.pdf
08/13/2015
8 USC 1182(a)(1)(A)
Attachment E 8 USC § 1182(a)(1)(A).pdf
08/13/2015
42 USC 252
Attachment F 42 USC § 252.pdf
08/13/2015
42 CFR 34
Attachment G 42 CFR 34.pdf
08/13/2015
Section 301 of PHSA
Attachment H Section 301 of the Public Health Service Act (42 USC 241).pdf
08/13/2015
Participant Information Sheet
Attachment K Participant Information Sheet 7.1.15.docx
08/13/2015
Chikungunya and Dengue Messages
Attachment L Chikungunya and Dengue Messages.docx
08/13/2015
Infographic Materials English/Spanish
Attachment M Infographic materials_English and Spanish_FINAL.docx
08/13/2015
IRB Research Determination
Attachment O IRB Non-Research Determination.pdf
08/13/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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