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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Information Collection to Assess the Viajo sin Zika Awareness Communication Campaign for Hispanics/Latinos Visiting Friends and Relatives
Agency IC Tracking Number:
0920-0932 18AVH
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
Viajo sin Zika Online Focus Group Screener - English
Att D - Online screener.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0932
Viajo sin Zika Online Focus Group Screener - Spanish
Att D - Online screener (Spanish).docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0932
Viajo sin Zika Online Focus Group Moderator Guide - English
Att E - Focus Group Moderators Guide.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0932
Viajo sin Zika Online Focus Group Moderator Guide - Spanish
Att E - Focus Group Moderators Guide (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:
216
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
216
0
216
0
0
0
Annual IC Time Burden (Hours)
84
0
84
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Email Invitation to Partner Organizations
Att A - Email invitation to partner organizations.docx
08/15/2018
Email Invitation to Partner Organization Members
Att B - Email invitation to partner organization members.docx
08/15/2018
Recruitment Flyer - English
Att C - Recruitment Flyer.docx
08/15/2018
Recruitment Flyer - Spanish
Att C - Recruitment Flyer (Spanish).docx
08/15/2018
IRB Determination
Att F - IRB Determination.pdf
08/15/2018
Supporting Statement A
Viajo sin Zika_Supporting Statement A_8.9.18_FINAL.docx
08/15/2018
Supporting Statement B
Viajo sin Zika_Supporting Statement B_8.9.18.docx
08/15/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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