Document Name Document Type
HMTS - Formative evaluation of Zika prevention strategies and messages among pregnant women and community leaders in Puerto Rico Form and Instruction
Focus Group Discussion with Community Leaders in Puerto 26FEB2016 FGD for assessing ACTIONS among community leaders.docx Form and Instruction
Focus Group Discussion with Pregnant Women in Puerto Ric 26FEB2016 FGD for assessing ACTIONS among pregnant women.docx Form and Instruction
Focus Group Discussion with Pregnant Women in Puerto Ric 26FEB2016 FGD for testing messages with pregnant women.docx Form and Instruction
In-depth Interview of Community Leaders in Puerto Rico t 26FEB2016 IDI for assessing ACTIONS among community leaders.docx Form and Instruction
In-depth Interview of Pregnant Women in Puerto Rico to E 26FEB2016 IDI for assessing ACTIONS among pregnant women.docx Form and Instruction
In-depth Interview of Pregnant Women in Puerto Rico To T 26FEB2016 IDI for testing messages with pregnant women.docx Form and Instruction
Appendix A -- Question bank item numbers.docx Question Bank Item Number - Appendix A IC Document
ZikaMessaging_concept.pdf Health Message - Zika English IC Document
Message concepts for IDIs and focus groups in Puerto Rico REVISED and CLEAREDOADC Spanish.pptx Health Message - Zika Spanish Text IC Document
HMTSExpeditedReviewForm - Zika in PR.pdf HMTS - Zika Expedited Review Template - signed OADC IC Document
ZikaMessaging_concept_Spanish.pdf Health Message - Zika Spanish IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HMTS - Formative evaluation of Zika prevention strategies and messages among pregnant women and community leaders in Puerto Rico	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Electronic Capability
Form and Instruction	NA	Focus Group Discussion with Community Leaders in Puerto Rico to Explore Possible Actions for Preventing Zika	26FEB2016 FGD for assessing ACTIONS among community leaders.docx	NA	No	Paper Only
Form and Instruction	NA	Focus Group Discussion with Pregnant Women in Puerto Rico to Explore Possible Actions for Preventing Zika	26FEB2016 FGD for assessing ACTIONS among pregnant women.docx	NA	No	Paper Only
Form and Instruction	NA	Focus Group Discussion with Pregnant Women in Puerto Rico To Test Zika Prevention Messages	26FEB2016 FGD for testing messages with pregnant women.docx	NA	No	Paper Only
Form and Instruction	NA	In-depth Interview of Community Leaders in Puerto Rico to Explore Possible Actions for Preventing Zika	26FEB2016 IDI for assessing ACTIONS among community leaders.docx	NA	No	Paper Only
Form and Instruction	NA	In-depth Interview of Pregnant Women in Puerto Rico to Explore Possible Actions for Preventing Zika	26FEB2016 IDI for assessing ACTIONS among pregnant women.docx	NA	No	Paper Only
Form and Instruction	NA	In-depth Interview of Pregnant Women in Puerto Rico To Test Zika Prevention Messages	26FEB2016 IDI for testing messages with pregnant women.docx	NA	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	270	270
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Question Bank Item Number - Appendix A	Appendix A -- Question bank item numbers.docx	02/26/2016
Health Message - Zika English	ZikaMessaging_concept.pdf	03/02/2016
Health Message - Zika Spanish Text	Message concepts for IDIs and focus groups in Puerto Rico REVISED and CLEAREDOADC Spanish.pptx	03/02/2016
HMTS - Zika Expedited Review Template - signed OADC	HMTSExpeditedReviewForm - Zika in PR.pdf	03/02/2016
Health Message - Zika Spanish	ZikaMessaging_concept_Spanish.pdf	03/02/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

HMTS - Formative evaluation of Zika prevention strategies and messages among pregnant women and community leaders in Puerto Rico