Zika virus persistence in body fluids of patients with Zika virus infection in Puerto Rico (ZIPER Study)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Contact Information Form	Form	New	Available
Shedding Eligibility	Form and Instruction	New	Available
Baseline and Follow-Up Questionnaire - Asymptomatic	Form and Instruction	New	Available
Baseline and Follow-Up Questionnaire - Symptomatic	Form and Instruction	New	Available
Attachment M ZiPER Pregnancy Questionnaire.docx	Supplementary Document	Uploaded 2016-09-30	Available
SSB - Puerto Rico Shedding 9-28-2016clean.docx	Supporting Statement B	Uploaded 2016-09-30	Available
SSA - Puerto Rico Shedding_OMB2 09 28 2016 Clean.docx	Supporting Statement A	Uploaded 2016-09-30	Available
Att. L - IRB approval.pdf	Supplementary Document	Uploaded 2016-07-12	Available
Att. K - Counseling messages.docx	Supplementary Document	Uploaded 2016-07-12	Available
Att. J - Laboratory Form.docx	Supplementary Document	Uploaded 2016-07-12	Available
Att. I - Protocol for specimen collection ESP.docx	Supplementary Document	Uploaded 2016-07-12	Available
Att. I - Protocol for specimen collection.docx	Supplementary Document	Uploaded 2016-07-12	Available
Att. F - ZIPER Phone Recruitment Script ESP.docx	Supplementary Document	Uploaded 2016-07-12	Repair queued
Att. F - ZIPER Phone Recruitment Script.docx	Supplementary Document	Uploaded 2016-07-12	Available
Att. E - Consent forms ESP.docx	Supplementary Document	Uploaded 2016-07-12	Available
Att. E - Consent forms.docx	Supplementary Document	Uploaded 2016-07-12	Available
Att. C - Model coupon.docx	Supplementary Document	Uploaded 2016-07-12	Available
Att. B1 -- Public Comment.pdf	Supplementary Document	Uploaded 2016-06-30	Available
Att. B - 60-Day FRN.pdf	Supplementary Document	Uploaded 2016-06-30	Available
Att. A - Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2016-06-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
222428	Contact Information Form	Form	New
222266	Shedding Eligibility	Form and Instruction	New
222265	Baseline and Follow-Up Questionnaire - Asymptomatic	Form and Instruction	New
222264	Baseline and Follow-Up Questionnaire - Symptomatic	Form and Instruction	New

ICR Details

OMB Control No: 0920-1140	ICR Reference No: 201606-0920-022
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-16ARP
Title: Zika virus persistence in body fluids of patients with Zika virus infection in Puerto Rico (ZIPER Study)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/05/2016
	Date Received in OIRA: 07/13/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	12 Months From Approved
Responses	3,400	0	0
Time Burden (Hours)	407	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The ZIPER study will help inform the presence and duration of ZIKV shedding in several body fluids among RT-PCR-positive ZIKV cases from Puerto Rico. It will also provide information regarding the duration of detection of anti-ZIKV IgM antibodies and the time for development of IgG antibodies among the same population. In addition, this study will determine the prevalence of anti-ZIKV, IgM and IgG, and virus shedding in body fluids among household contacts of ZIKV cases. This ICR is submitted as a New collection to allow information collection activities to continue past Emergency Clearance deadline.

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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
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 26231	05/02/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 44865	07/11/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Baseline and Follow-Up Questionnaire - Symptomatic	NA, NA	Baseline and Follow-Up Questionnaire - Spanish 29SEP2016 ,   Baseline and Follow-Up Questionnaire - English 29SEP2016
Baseline and Follow-Up Questionnaire - Asymptomatic	NA, NA	Baseline and Follow-Up Questionnaire - Spanish 29SEP2016 ,   Baseline and Follow-Up Questionnaire - English 29SEP2016
Shedding Eligibility	NA	Participant Eligibility Form
Contact Information Form	NA	Contact Information Form

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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	3,400	0	0	3,400	0	0
Annual Time Burden (Hours)	407	0	0	407	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 0920-16ARP is a New ICR for continuation of Zika-related activities beyond Emergency Clearance.

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Annual Cost to Federal Government: $109,522

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: 07/13/2016

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