Information Collection to Assess the Viajo sin Zika Awareness Communication Campaign for Hispanics/Latinos Visiting Friends and Relatives

Information Collection for Evaluation of Education, Communication, and Training Activities for Mobile Populations

Documents and Forms

Document Name Document Type
Form 0920-0932 Information Collection to Assess the Viajo sin Zika Awareness Communication Campaign for Hispanics/Latinos Visiting Friends and Relatives Form and Instruction
0920-0932 Viajo sin Zika Online Focus Group Screener - English Att D - Online screener.docx Form and Instruction
0920-0932 Viajo sin Zika Online Focus Group Screener - Spanish Att D - Online screener (Spanish).docx Form and Instruction
0920-0932 Viajo sin Zika Online Focus Group Moderator Guide - Engl Att E - Focus Group Moderators Guide.docx Form and Instruction
0920-0932 Viajo sin Zika Online Focus Group Moderator Guide - Span Att E - Focus Group Moderators Guide (Spanish).docx Form and Instruction
Att A - Email invitation to partner organizations.docx Email Invitation to Partner Organizations IC Document
Att B - Email invitation to partner organization members.docx Email Invitation to Partner Organization Members IC Document
Att C - Recruitment Flyer.docx Recruitment Flyer - English IC Document
Att C - Recruitment Flyer (Spanish).docx Recruitment Flyer - Spanish IC Document
Att F - IRB Determination.pdf IRB Determination IC Document
Viajo sin Zika_Supporting Statement A_8.9.18_FINAL.docx Supporting Statement A IC Document
Viajo sin Zika_Supporting Statement B_8.9.18.docx Supporting Statement B IC Document

Information Collection (IC) Details

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

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 Agency Discretion
Annual Number of Responses for this IC	216	216
Annual IC Time Burden (Hours)	84	84
Annual IC Cost Burden (Dollars)	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.