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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Knowledge, Attitudes, and Practices about Dengue, Chikungunya, and Zika among Travel Consultants and Aid Agencies
Agency IC Tracking Number:
0920-0932-17AML
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
Instruction
Attachment D Script for Telephone Calls to Screen and Recruit Participants of Focus Groups with Staff and Missionaries_Volunteers of Sending Agencies - English.docx
NA
No
Paper Only
Instruction
Attachment D1 Script for Telephone Calls to Screen and Recruit Participants of Focus Groups with Staff and Missionaries_Volunteers of Sending Agencies - Spanish (003).docx
NA
No
Paper Only
Form and Instruction
NA
Moderator’s Guide of Questions for Focus Groups with Sending Agencies - English
Attachment A - Moderator's Guide of Questions for Focus Group 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 A1 - Moderator's Guide of Questions for Focus Group with Sending Agencies - Spanish.docx
NA
Yes
Yes
Fillable Fileable
Instruction
Attachment D Script for Telephone Calls to Screen and Recruit Participants of Focus Groups with Staff and Missionaries_Volunteers of Sending Agencies - English.docx
NA
No
Paper Only
Instruction
Attachment D1 Script for Telephone Calls to Screen and Recruit Participants of Focus Groups with Staff and Missionaries_Volunteers of Sending Agencies - Spanish (003).docx
NA
No
Paper Only
Form and Instruction
NA
Moderator’s Guide of Questions for Focus Groups with Missionairies/Volunteers - English
Attachment B - Moderator’s Guide for Focus Groups with Missionaries_Volunteers - English.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
NA
Moderator’s Guide of Questions for Focus Groups with Missionairies/Volunteers - Spanish
Attachment B1 - Moderator's Guide for Missionaries_Volunteers - 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:
270
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
270
0
270
0
0
0
Annual IC Time Burden (Hours)
46
0
46
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 C - Verbal Consent for Participants for Focus Group regarding Travel Health Messages - English.docx
05/24/2017
Verbal Consent for Participants of Focus Group regarding Travel Health Messages - Spanish
Attachment C1 - Verbal Consent for Participants for Focus Group regarding Travel Health Messages - Spanish.docx
05/24/2017
Project Description
Attachment E - Protocol 6009 Knowledge Attitudes and Practices about Travel Health among Aid Agency Staff and Volunteers.docx
05/24/2017
Research Determination - Exemtion of Amendment
Attachment F - Exemption Determination Letter.docx
05/24/2017
Instructions for the Participation in Focus Group Discussions - English
Attachment G - Instructions for the Participation in Focus Group Discussions - English.docx
05/24/2017
Instructions for the Participation in Focus Group Discussions - Spanish
Attachment G1 - Instructions for the Participation in Focus Group Discussions - Spanish.docx
05/24/2017
Supporting Statement A
SSA (0920-0932) Dengue_Chik_Zika KAP_Travel Consultants and Aid Agencies cpg 05.19.2017.docx
05/24/2017
Supporting Statement B
SSB (0920-0932) Dengue_Chik_Zika KAP_Travel Consultants and Aid Agencies cpg 05.19.2017.docx
05/24/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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