Zika Emergency Package V: Assessment of Interventions Intended to Protect Pregnant Women in Puerto Rico from Zika virus Infections

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Telephone Interview of Cases and Controls	Form and Instruction	New	Available
Follow-Up Telephone Interview	Form and Instruction	New	Available
Initial Telephone Interview	Form and Instruction	New	Available
Attachment H.Logic Model of Puerto Rico Zika Response Activities.pptx	Supplementary Document	Uploaded 2016-06-17	Available
Attachment G.IRB determination letter for project 2.pdf	Supplementary Document	Uploaded 2016-06-17	Available
Attachment F.Projet 1.IRB letter of determination.pdf	Supplementary Document	Uploaded 2016-06-17	Available
Statement B 16JUN2016 FINAL.docx	Supporting Statement B	Uploaded 2016-06-17	Available
Statement A 16JUN2016 FINAL.docx	Supporting Statement A	Uploaded 2016-06-17	Available
Emergency Review Request Memo - Zika 5 SIGNED.pdf	Supplementary Document	Uploaded 2016-06-10	Available
Att. B - Draft 60-Day FRN.docx	Supplementary Document	Uploaded 2016-06-10	Available
Att. A - Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2016-06-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
222028	Telephone Interview of Cases and Controls	Form and Instruction	New
221889	Follow-Up Telephone Interview	Form and Instruction	New
221888	Initial Telephone Interview	Form and Instruction	New

ICR Details

OMB Control No: 0920-1118	ICR Reference No: 201606-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 16AQV
Title: Zika Emergency Package V: Assessment of Interventions Intended to Protect Pregnant Women in Puerto Rico from Zika virus Infections
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 06/17/2016
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/17/2016
	Date Received in OIRA: 06/17/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	6 Months From Approved
Responses	2,900	0	0
Time Burden (Hours)	892	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC requests an Emergency Clearance to collect data for six months. The goal of this project is to find out if interventions are reaching pregnant women and having the intended effects along with getting feedback from pregnant women about the Zika prevention activities that have been implemented (e.g., Zika education sessions and prevention kits, vector control services, and communication activities). Findings will be used to improve the delivery of interventions and to inform decisions about future Zika prevention activities for pregnant women in Puerto Rico.

Emergency Justfication: CDC needs this assessment to ensure that Zika prevention activities effectively educate, equip, and encourage women to participate in as many Zika prevention behaviors as possible. On-going evaluation is an important part of this program because it can reveal novel ways that women protect themselves from Zika, how effective the distribution of the Zika Prevention Kit has been in Puerto Rico, perceived severity and susceptibility to Zika, pregnant women’s self-efficacy in protecting themselves from Zika after the interventions have been implemented, as well as the extent to which target populations are using contents of the Zika Prevention Kit.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Initial Telephone Interview	NA, NA	Initial Telephone Interview - English ,   Initial Telephone Interview - Spanish
Follow-Up Telephone Interview	NA, NA	Follow-Up Interview - English ,   Follow-Up Interview - Spanish
Telephone Interview of Cases and Controls	NA, NA	Case Control Telephone Interview - English ,   Case Control Telephone Interview - Spanish

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ICR Summary of Burden

table that charts list of burden

	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	2,900	0	0	2,900	0	0
Annual Time Burden (Hours)	892	0	0	892	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Submission of 0920-16AQV is a New Emergency ICR.

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Annual Cost to Federal Government: $60,829

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 06/17/2016

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