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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Knowledge, Attitudes, and Practices about Dengue and Chikungunya among Travel Consultants and Aid Agencies
Agency IC Tracking Number:
15BFS
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
Moderator’s Guide of Questions for Focus Groups with Sending Agencies - English
Attachment C - Moderator’s Guide of Questions for Focus Groups with Sending Agencies - English.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
NA
Moderator’s Guide of Questions for Focus Groups with Sending Agencies - Spanish
Attachment C.1 - Moderator’s Guide of Questions for Focus Groups with Sending Agencie - Spanish.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
NA
Moderator’s Guide for Focus Groups with Volunteers - English
Attachment D – Moderator’s Guide for Focus Groups with Volunteers - English.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
NA
Moderator’s Guide for Focus Groups with Volunteers - Spanish
Attachment D.1 - Moderator’s Guide for Focus Groups with Volunteers - Spanish.docx
NA
Yes
Yes
Fillable Fileable
Instruction
Attachment I – Instructions for the Participation in Focus Group Discussions - English.docx
NA
Yes
Yes
Fillable Fileable
Instruction
Attachment I1 - Instructions for the Participation in Focus Group DiscussionsSpanish.docx
NA
Yes
Yes
Fillable Fileable
Instruction
Attachment H Script for Telephone Calls to Screen and Recruit Participants - English.docx
NA
No
Fillable Fileable
Instruction
Attachment H 1 - Script for Telephone Calls to Screen and Recruit Participants - Spanish.docx
NA
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:
360
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
360
0
360
0
0
0
Annual IC Time Burden (Hours)
54
0
54
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Verbal Consent for Participants of Focus Group regarding Travel Health Messages - English
Attachment E – Verbal Consent for Participants of Focus Group regarding Travel Health Messages - English.docx
10/13/2015
Verbal Consent for Participants of Focus Group regarding Travel Health Messages - Spanish
Attachment E.1 - Verbal Consent for Participants of Focus Group regarding Travel Health Messages - Spanish.docx
10/13/2015
Supporting Statement B
Statement B - 0920-0932 Dengue and Chikungunya KAP_Travel Consultants and Aid Agencies.docx
10/30/2015
Supporting Statement A
Statement A - 0920-0932 Dengue and Chikungunya KAP_Travel Consultants and Aid Agencies.docx
11/03/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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