Emergency Zika Package: Zika Postpartum Emergency Response Survey, Puerto Rico, 2016

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Zika Virus Infection Questions for Zika Postpartum Emergency Response (ZPER) Survey	Form and Instruction	New	Available
Att F - Sampling and Methods_ZPER.docx	Supplementary Document	Uploaded 2016-07-28	Available
Postpartum Zika SSB - Emergency Zika Package_ZPER_072116_OMB_SRE_clean.docx	Supporting Statement B	Uploaded 2016-07-28	Available
Postpartum Zika SSA - Emergency Zika Package ZPER_072116_OMB2_SRE clean.docx	Supporting Statement A	Uploaded 2016-07-28	Available
Att D - Human Subjects_Consent_ZPER_28JUL2016.docx	Supplementary Document	Uploaded 2016-07-28	Available
Emergency Clearance_Zika 7_13_16.pdf	Supplementary Document	Uploaded 2016-07-28	Available
Att C - Draft 60-day FRN_ZPER_063016.docx	Supplementary Document	Uploaded 2016-07-28	Available
Att A - Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2016-07-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
222720	Zika Virus Infection Questions for Zika Postpartum Emergency Response (ZPER) Survey	Form and Instruction	New

ICR Details

OMB Control No: 0920-1127	ICR Reference No: 201607-0920-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 16AVK
Title: Emergency Zika Package: Zika Postpartum Emergency Response Survey, Puerto Rico, 2016
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: 08/01/2016
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/01/2016
	Date Received in OIRA: 08/01/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2017	6 Months From Approved
Responses	2,760	0	0
Time Burden (Hours)	690	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: To conduct a rapid, population-based assessment of maternal behaviors and experiences related to Zika virus exposure among recently pregnant women in Puerto Rico. The intended use of the data is to provide information on prenatal experiences such as discussions with providers, testing for Zika and sources of information, as well as behaviors employed to reduce sexual and vector-based exposure to the Zika virus.

Emergency Justfication: Not much is known about incidence of Zika in pregnant women, and data on pregnant women infected with Zika are limited. A rapid assessment of maternal-related behaviors and experiences in regard to Zika virus in Puerto Rico will provide information on prenatal experiences such as discussions with providers, testing for Zika and sources of information, as well as behaviors employed to reduce sexual and vector-based exposure to the Zika virus.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

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: 1

table that charts list of burden

IC Title	Form No.	Form Name
Zika Virus Infection Questions for Zika Postpartum Emergency Response (ZPER) Survey	NA	Zika PostparEmergency Response (ZPER) Questionnaire

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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	2,760	0	0	2,760	0	0
Annual Time Burden (Hours)	690	0	0	690	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: 0920-16AVK is a New Emergency ICR that is being submitted for Zika Virus-related activities.

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Annual Cost to Federal Government: $400,587

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: 08/01/2016

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