View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Evaluation of Travelers' Health Zika Prevention Communication Campaign for HispanicsLatinos Visiting Friends and Family Word of Mouth Survey (Pre/Post Test) 0920-18JU
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Yes Yes Fillable Fileable

Health Public Health Monitoring

 

800 0
   
Individuals or Households
 
   50 %

  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 800 0 800 0 0 0
Annual IC Time Burden (Hours) 132 0 132 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att C1_ENCUESTA SOBRE LA INFORMACION RECIBIDA DE PERSONA A PERSONA 12/20/2017
Supporting Statement A 12/20/2017
Supporting Statement B 12/20/2017
Att A_ Informed Consent Statement for Print Survey 12/20/2017
Att A1_INFORMED CONSENT STATEMENT (PRINTED SPANISH VERSION) 12/20/2017
Att B_Informed Consent Statement for Online Survey 12/20/2017
Att B1_INFORMED CONSENT STATEMENT (ONLINE SPANISH VERSION) 12/20/2017
Att D_DETERMINATION OF NON-APPLICABILITY OF HUMAN SUBJECT REGULATIONS 12/20/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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