Information Collection

Zika Family Survey: In-Depth Interviews with Women Affected by Zika Virus

IC 230823 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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment A Intro Letter to Participants.docx	Instruction
Attachment C Follow Up Script and_FAQs.docx	Instruction
0920-1154 IN-DEPTH INTERVIEWS WITH WOMEN AFFECTED BY THE ZIKA VIRU Attachment E Interview Guide.docx	Form and Instruction
Attachment D Consent Form.docx Interview Consent Form	IC Document
Attachment B Letter to Doctors.docx Letter to Doctor	IC Document
Attachment F IRB Approval STUDY00020014.pdf IRB Approval - RTI	IC Document
Support Statement A_Zika Family Survey.doc Supporting Statement A	IC Document
Support Statement B_ Zika Family Survey.docx Supporting Statement B	IC Document

IC Title:

Zika Family Survey: In-Depth Interviews with Women Affected by Zika Virus

Agency IC Tracking Number:

0920-1154-18WT

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?	Electronic Capability
Instruction			Attachment A Intro Letter to Participants.docx	NA	No	Paper Only
Instruction			Attachment C Follow Up Script and_FAQs.docx	NA	No	Paper Only
Form and Instruction	0920-1154	IN-DEPTH INTERVIEWS WITH WOMEN AFFECTED BY THE ZIKA VIRUS - INTERVIEW GUIDE	Attachment E Interview Guide.docx	NA	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 260

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	260	260
Annual IC Time Burden (Hours)	85	85
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Interview Consent Form	Attachment D Consent Form.docx	04/03/2018
Letter to Doctor	Attachment B Letter to Doctors.docx	04/03/2018
IRB Approval - RTI	Attachment F IRB Approval STUDY00020014.pdf	04/03/2018
Supporting Statement A	Support Statement A_Zika Family Survey.doc	04/03/2018
Supporting Statement B	Support Statement B_ Zika Family Survey.docx	04/03/2018

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