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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
[NCZEID] Focus Groups and In-Depth Interviews with Travelers and Travel Medicine Specialists
Agency IC Tracking Number:
IC Status:
Unchanged
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
0920-24ID
Recruitment Screener
Attch 1 - Intl Travelers - Screener - English 08 08 2024.docx
Yes
Yes
Fillable Fileable
Form
0920-24ID
Consent Form
Attch 2 - Intl Travelers - Consent Form - English 08 08 2024.docx
Yes
Yes
Fillable Fileable
Form
0920-24ID
Focus Group Guide
Attch 3 - Intl Travelers - Focus Group Guide - English 08 08 2024.docx
Yes
Yes
Fillable Fileable
Form
0920-24ID
Interview Recruitment Screener
Attch 7 - Travel Med Specialists - Screener_08 08 2024.docx
Yes
Yes
Fillable Fileable
Form
0920-24ID
Travel Med Specialists - Consent Form
Attch 8 - Travel Med Specialists - Consent Form 08 08 2024.docx
Yes
Yes
Fillable Fileable
Form
0920-24ID
Travel Med Specialists - Interview Guide
Attch 9 - Travel Med Specialists - IDI Guide 08 08 2024.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
672
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
672
0
0
0
0
672
Annual IC Time Burden (Hours)
132
0
0
0
0
132
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Recruitment Screener_ Spanish
Attch 4 - Intl Travelers - Screener - Spanish 08 08 2024.docx
08/16/2024
Consent Form_ Spanish
Attch 5 - Intl Travelers - Consent Form - Spanish 08 08 2024.docx
08/16/2024
Consent Form - Spanish
Attch 5 - Intl Travelers - Consent Form - Spanish 08 08 2024.docx
08/16/2024
Human Subjects Determination
Attch 10- Human Subjects Determination.pdf
08/16/2024
MEMO_ GenIC
GenIC Request Form 08 08 2024.docx
08/16/2024
SSA
Supporting Statement A 8 08 2024.docx
08/16/2024
SSB
Supporting Statement B 08 08 2024.docx
08/16/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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The .gov means it's official.
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