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Formative Evaluation of Zika Prevention Kits for Pregnant Women in Puerto Rico
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0920-1071
IC ID: 220174
OMB.report
HHS/CDC
OMB 0920-1071
ICR 201503-0920-011
IC 220174
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1071 can be found here:
2024-05-08 - Revision of a currently approved collection
2024-03-22 - No material or nonsubstantive change to a currently approved collection
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
View Information Collection (IC)
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
Federal Enterprise Architecture Business Reference Module
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
70
0
70
0
0
0
Annual IC Time Burden (Hours)
18
0
18
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.