Formative Evaluation of Zika Prevention Kits for Pregnant Women in Puerto Rico

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1071 can be found here:

Documents and Forms

Document Name Document Type
Formative Evaluation of Zika Prevention Kits for Pregnant Women in Puerto Rico Form and Instruction
Intercept Interview of Pregnant Women in Puerto Rico ZP Kit_Intercept Interview Guide_APPROVED BY PRDOH.DOCX Form and Instruction
Fast_Track_GenIC_Request for ZPK feeedback from pregnant women.DRAFT.DOCX Fast Track GenIC Request Zika Intercept Interview IC Document

Information Collection (IC) Details

IC Title:	Formative Evaluation of Zika Prevention Kits for Pregnant Women in Puerto Rico	Agency IC Tracking Number:	16QG

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Intercept Interview of Pregnant Women in Puerto Rico	ZP Kit_Intercept Interview Guide_APPROVED BY PRDOH.DOCX	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70	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	70	70
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track GenIC Request Zika Intercept Interview	Fast_Track_GenIC_Request for ZPK feeedback from pregnant women.DRAFT.DOCX	02/19/2016

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