Information Collection

Assessment of the Zika Care Connect Program

IC 229528 under ICR 201610-0920-009 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1154 Assessment of the Zika Care Connect Program	Form and Instruction
0920-1154 Invitation Email to access Survey - Health Care Professi Attachment 6_Email and Reminder Email - Survey of Healthcare Professiona....docx	Form and Instruction
0920-1154 Reminder Invitation Email to access Survey - Health Care Attachment 6_Email and Reminder Email - Survey of Healthcare Professiona....docx	Form and Instruction
0920-1154 Survey - Healthcare Professional Attachment 4_Information Collection Instrument - Survey of Healthcare Pr....docx	Form and Instruction
0920-1154 Pop-Up Invitation to Survey - Website User Attachment 5_Information Collection Instrument - Survey of Website Users....docx	Form and Instruction
0920-1154 Survey - Website User Attachment 5_Information Collection Instrument - Survey of Website Users....docx	Form and Instruction
SSA_ZCC eval_ver2_clean.docx Supporting Statement A	IC Document
SSB_ZCC evaluation_ver2_clean.docx Supporting Statement B	IC Document
Attachment 3_ IRB determination Letter.pdf IRB Determination	IC Document

IC Title:

Assessment of the Zika Care Connect Program

Agency IC Tracking Number:

0920-1154-18JN

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1154	Invitation Email to access Survey - Health Care Professional	Attachment 6_Email and Reminder Email - Survey of Healthcare Professiona....docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Reminder Invitation Email to access Survey - Health Care Professional	Attachment 6_Email and Reminder Email - Survey of Healthcare Professiona....docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Survey - Healthcare Professional	Attachment 4_Information Collection Instrument - Survey of Healthcare Pr....docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Pop-Up Invitation to Survey - Website User	Attachment 5_Information Collection Instrument - Survey of Website Users....docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Survey - Website User	Attachment 5_Information Collection Instrument - Survey of Website Users....docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,080

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,080	4,080
Annual IC Time Burden (Hours)	260	260
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	SSA_ZCC eval_ver2_clean.docx	12/26/2017
Supporting Statement B	SSB_ZCC evaluation_ver2_clean.docx	12/26/2017
IRB Determination	Attachment 3_ IRB determination Letter.pdf	12/26/2017

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