OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Assessment of a Preventive Service Program in the Context of a Zika Virus Outbreak in Puerto Rico

ICR 201902-0920-017 · OMB 0920-1241 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
30-month Follow-up Survey for Z-CAN patients who did not complete the 18-month Follow-up Survey Form and Instruction Unchanged Repair queued
30-month Follow-up Survey for Z-CAN patients who completed the 18-month Follow-up Survey Form and Instruction Unchanged Available
18-month Follow-up Survey for Z-CAN patients Form and Instruction Unchanged Available
0920-1241 Change Request Justification 2-15-2019.docx Justification for No Material/Nonsubstantive Change Uploaded 2019-02-22 Available
Att I Referenced articles.pdf Supplementary Document Uploaded 2018-07-20 Available
Att G Consent_Online Survey_18_30_ZCAN women (Eng and Span).docx Supplementary Document Uploaded 2018-07-20 Available
Att F Invitation_Online Survey_18_30_ZCAN women (Eng and Span).docx Supplementary Document Uploaded 2018-07-20 Repair queued
Att E Interim contacts with ZCAN women (Eng and Span).docx Supplementary Document Uploaded 2018-07-20 Repair queued
Att D-2 UPR IRB approval letter.pdf Supplementary Document Uploaded 2018-07-20 Available
Att D-1 CDC IRB approval letter.pdf Supplementary Document Uploaded 2018-07-20 Available
Att C Privacy Act Determination.pdf Supplementary Document Uploaded 2018-07-20 Repair queued
Att B-1 60-day FRN March 30 2018.pdf Supplementary Document Uploaded 2018-07-20 Available
Att A-Section 301 of the PHS Act.pdf Supplementary Document Uploaded 2018-07-20 Available
SSB_Z-CAN_07022018.docx Supporting Statement B Uploaded 2018-07-20 Available
SSA_Z-CAN_07022018.docx Supporting Statement A Uploaded 2018-07-20 Available
IC Document Collections
IC IDCollectionTypeStatusForm
232335 30-month Follow-up Survey for Z-CAN patients who did not complete the 18-month Follow-up Survey Form and Instruction Unchanged
232334 30-month Follow-up Survey for Z-CAN patients who completed the 18-month Follow-up Survey Form and Instruction Unchanged
232333 18-month Follow-up Survey for Z-CAN patients Form and Instruction Unchanged
ICR Details
0920-1241 201902-0920-017
Historical Active 201806-0920-010
HHS/CDC 0920-1241-19YM
Assessment of a Preventive Service Program in the Context of a Zika Virus Outbreak in Puerto Rico
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 03/12/2019
Retrieve Notice of Action (NOA) 02/26/2019
Previous terms continue: Approved consistent with the understanding that CDC - in collaboration with the University of Puerto Rico - is confident that the internet access in Puerto Rico necessary to conduct this information collection is now stable and sufficient.
  Inventory as of this Action Requested Previously Approved
08/31/2020 08/31/2020 08/31/2020
1,840 0 1,840
259 0 259
1,875 0 1,875
The purpose of this project is to assess the implementation and associated outcomes of the Zika Contraception Access Network (Z-CAN), an initiative that provided patient-centered services to reproductive-aged women in Puerto Rico who chose to delay or avoid pregnancy while local Zika virus transmission was ongoing. This Non-Substantive Change is being requested to increase the value of the gift card given to women who participate in the 18- and 30-month follow-up surveys as a token of appreciation from $5 to $10 as means to improve participation. The requested change does not affect any other component of the information collection.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  83 FR 13752 03/30/2018
83 FR 34588 07/20/2018
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 1,840 1,840 0 0 0 0
Annual Time Burden (Hours) 259 259 0 0 0 0
Annual Cost Burden (Dollars) 1,875 1,875 0 0 0 0
No
No
Z-CAN patients will be asked to respond to online surveys at approximately 18 and 30 months after their initial Z-CAN visit. Since women’s satisfaction with their contraceptive method and continued use of that method may vary over time, it is important to assess these outcomes, as well as unmet need for services and reproductive health outcomes over a longer period including after the end of Z-CAN. Some concerns may only become apparent with longer-term assessment, such as changes in utilization or satisfaction with chosen contraceptive methods, whether women are readily able to access services they are eligible for from a Z-CAN provider during or after the program (i.e., no-cost removal of intrauterine devices and implants), and ongoing unmet needs for services after the program. Collecting this information from Z-CAN patients less frequently will preclude this assessment.
$706,784
No
    Yes
    Yes
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.
02/26/2019