Information Collection

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

IC 220252 under ICR 201502-0920-001 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.