OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Emergency Zika Package: Zika Postpartum Emergency Response Survey, Puerto Rico, 2016

ICR 201607-0920-004 · OMB 0920-1127 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Zika Virus Infection Questions for Zika Postpartum Emergency Response (ZPER) Survey Form and Instruction New Available
Att F - Sampling and Methods_ZPER.docx Supplementary Document Uploaded 2016-07-28 Available
Postpartum Zika SSB - Emergency Zika Package_ZPER_072116_OMB_SRE_clean.docx Supporting Statement B Uploaded 2016-07-28 Available
Postpartum Zika SSA - Emergency Zika Package ZPER_072116_OMB2_SRE clean.docx Supporting Statement A Uploaded 2016-07-28 Available
Att D - Human Subjects_Consent_ZPER_28JUL2016.docx Supplementary Document Uploaded 2016-07-28 Available
Emergency Clearance_Zika 7_13_16.pdf Supplementary Document Uploaded 2016-07-28 Available
Att C - Draft 60-day FRN_ZPER_063016.docx Supplementary Document Uploaded 2016-07-28 Available
Att A - Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document Uploaded 2016-07-28 Available
IC Document Collections
IC IDCollectionTypeStatusForm
222720 Zika Virus Infection Questions for Zika Postpartum Emergency Response (ZPER) Survey Form and Instruction New
ICR Details
0920-1127 201607-0920-004
Historical Active
HHS/CDC 16AVK
Emergency Zika Package: Zika Postpartum Emergency Response Survey, Puerto Rico, 2016
New collection (Request for a new OMB Control Number)   No
Emergency 08/01/2016
Approved with change 08/01/2016
Retrieve Notice of Action (NOA) 08/01/2016
  Inventory as of this Action Requested Previously Approved
02/28/2017 6 Months From Approved
2,760 0 0
690 0 0
0 0 0
To conduct a rapid, population-based assessment of maternal behaviors and experiences related to Zika virus exposure among recently pregnant women in Puerto Rico. The intended use of the data is to provide information on prenatal experiences such as discussions with providers, testing for Zika and sources of information, as well as behaviors employed to reduce sexual and vector-based exposure to the Zika virus.
Not much is known about incidence of Zika in pregnant women, and data on pregnant women infected with Zika are limited. A rapid assessment of maternal-related behaviors and experiences in regard to Zika virus in Puerto Rico will provide information on prenatal experiences such as discussions with providers, testing for Zika and sources of information, as well as behaviors employed to reduce sexual and vector-based exposure to the Zika virus.
US Code: 42 USC 241 Name of Law: PHSA
  
None
Not associated with rulemaking
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,760 0 0 2,760 0 0
Annual Time Burden (Hours) 690 0 0 690 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
0920-16AVK is a New Emergency ICR that is being submitted for Zika Virus-related activities.
$400,587
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/01/2016