Formative Research to Assess Pediatric Healthcare Providers Knowledge, Attitudes and Practices around Zika Virus

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Formative Research to Assess Pediatric Healthcare Providers Knowledge, Attitudes and Practices around Zika Virus Form
Survey of Experiences with and Attitudes towards Zika Vi Attachment A - Final AAP Survey Questions.docx Form
GenICRequest - AAP Survey Zika.docx genIC Request for Approval IC Document
Supporting Statement B.DOCX Supporting Statement B IC Document
Attachment B - IRB Exempt Approval Letter.pdf IRB Exemption IC Document
Attachment G - AAP Survey Incentives.docx Incentive Justification IC Document
Supporting Statement A.DOC Supporting Statement A IC Document
Attachment C - Survey Cover Letter.docx Survey Cover Letter IC Document
Attachment D - Survey Electronic Cover Letter.docx Survey Cover Letter - email IC Document
Attachment E - Federal Register Notice.pdf Generic Clearance FRN IC Document

Information Collection (IC) Details

IC Title:	Formative Research to Assess Pediatric Healthcare Providers Knowledge, Attitudes and Practices around Zika Virus	Agency IC Tracking Number:	0920-1154-18PQ

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	none	Survey of Experiences with and Attitudes towards Zika Virus	Attachment A - Final AAP Survey Questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,600	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,600	1,600
Annual IC Time Burden (Hours)	533	533
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
genIC Request for Approval	GenICRequest - AAP Survey Zika.docx	02/12/2018
Supporting Statement B	Supporting Statement B.DOCX	02/12/2018
IRB Exemption	Attachment B - IRB Exempt Approval Letter.pdf	02/12/2018
Incentive Justification	Attachment G - AAP Survey Incentives.docx	02/12/2018
Supporting Statement A	Supporting Statement A.DOC	02/12/2018
Survey Cover Letter	Attachment C - Survey Cover Letter.docx	02/12/2018
Survey Cover Letter - email	Attachment D - Survey Electronic Cover Letter.docx	02/12/2018
Generic Clearance FRN	Attachment E - Federal Register Notice.pdf	02/12/2018

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