OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Zika Reproductive Health Call-Back Survey (ZRHCS), Puerto Rico, 2017

ICR 201708-0920-024 · OMB 0920-1212 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Data Submission Layout - PRA BRFSS Coordinators Form New Available
Call-back Survey and Consent Form and Instruction New Available
Recruitment Script Form and Instruction New Available
Att 5 ZRHCS Non-research determination.pdf Supplementary Document Uploaded 2017-09-22 Available
Att 2b Public Comment 60 day FRN - ZRHCS.pdf Supplementary Document Uploaded 2017-09-22 Available
Att 2a 60d FRN - ZRHCS 27APR2017.pdf Supplementary Document Uploaded 2017-09-22 Available
Att 1 Authorizing Legislation - Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document Uploaded 2017-09-22 Repair queued
SSB - BRFSS PR Zika Call back_9-7-2017_clean.docx Supporting Statement B Uploaded 2017-09-22 Available
SSA - BRFSS PR Zika Call back_8-11-2017.docx Supporting Statement A Uploaded 2017-09-22 Available
IC Document Collections
IC IDCollectionTypeStatusForm
228476 Data Submission Layout - PRA BRFSS Coordinators Form New
228432 Call-back Survey and Consent Form and Instruction New
228431 Recruitment Script Form and Instruction New
ICR Details
0920-1212 201708-0920-024
Historical Active
HHS/CDC 0920-17ABU
Zika Reproductive Health Call-Back Survey (ZRHCS), Puerto Rico, 2017
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 12/22/2017
Retrieve Notice of Action (NOA) 09/28/2017
  Inventory as of this Action Requested Previously Approved
12/31/2018 12 Months From Approved
1,229 0 0
117 0 0
0 0 0
This study will continue collection of information approved by OMB under the Emergency ICR “Emergency Zika Package: Zika Reproductive Health Survey, Puerto Rico, 2017” (OMB Control No. 0920-1188). It will assess the current utilization of Zika prevention strategies targeted at women of reproductive age (18-49 years) in Puerto Rico, and determine the need for further refinements in educational messaging and allocation of resources, as established during the first season of the Zika outbreak. Information collected will be compared to 2016 survey data (OMB Control No. 0920-1114) to inform and evaluate Zika emergency response planning in Puerto Rico.
US Code: 42 USC 241 Name of Law: U.S. PHSA
  
None
Not associated with rulemaking
  82 FR 19370 04/27/2017
82 FR 43990 09/20/2017
Yes
  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 1,229 0 0 1,229 0 0
Annual Time Burden (Hours) 117 0 0 117 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
0920-17ABU is a New ICR being submitted to continue collection of Zika-related information initially approved under an Emergency Clearance.
$25,502
Yes Part B of Supporting Statement
    Yes
    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.
09/28/2017