Information Collection

Formative Research To Develop Zika Tools For Healthcare Providers

IC 231333 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Attachment F - Focus Group Discussion Guide.docx Other-Focus Group Discussion Guide -
0920-1154 ACOG Zika Virus Survey Attachment A - Survey of Ob-Gyns Mailed.docx Form
0920-1154 Focus Group Recruitment Screen Attachment G - Focus Group Recruitment Screener.docx Form and Instruction
0920-1154 ACOG Evaluation of Local Health Department Initiative Attachment I - LHD Survey.docx Form and Instruction
Attachment B - Survey of Ob-Gyns Email Invitation.docx Email Invitation (OB-GYN) IC Document
Attachment C - Survey of Ob-Gyns Email Reminders.docx Email Reminder (OB-GYN) IC Document
Attachment D - Survey of Ob-Gyns Mailing Cover Letter.docx Cover Letter Invitation IC Document
Attachment E - Survey of Ob-Gyns IRB Approval.pdf IRB Approval IC Document
Attachment J - LHD Survey Email Invitation.docx Email Invitation (Local Health Department) IC Document
Attachment K - LHD Survey Email Reminders.DOCX Email Reminder IC Document
Attachment L - LHD Survey IRB Approval.docx IRB Approval (Local Health Department) IC Document
Attachment H - Focus Group IRB Approval.docx ACOG Focus Group IRB Approval IC Document
Revised Supporting Statement A 04MAY2018.docx Supporting Statement A IC Document
Revised Supporting Statement B 04MAY2018.docx Supporting Statement B IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	FORMATIVE RESEARCH TO DEVELOP ZIKA TOOLS FOR HEALTHCARE PROVIDERS	Agency IC Tracking Number:	0920-1154-18WU

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
Other-Focus Group Discussion Guide - OB-GYN/PEDS/MIDWIVES/NPs			Attachment F - Focus Group Discussion Guide.docx	NA	No		Paper Only
Form	0920-1154	ACOG Zika Virus Survey	Attachment A - Survey of Ob-Gyns Mailed.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Focus Group Recruitment Screen	Attachment G - Focus Group Recruitment Screener.docx	NA	No		Paper Only
Form and Instruction	0920-1154	ACOG Evaluation of Local Health Department Initiative	Attachment I - LHD Survey.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,422	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,422	4,422
Annual IC Time Burden (Hours)	835	835
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Email Invitation (OB-GYN)	Attachment B - Survey of Ob-Gyns Email Invitation.docx	05/04/2018
Email Reminder (OB-GYN)	Attachment C - Survey of Ob-Gyns Email Reminders.docx	05/04/2018
Cover Letter Invitation	Attachment D - Survey of Ob-Gyns Mailing Cover Letter.docx	05/04/2018
IRB Approval	Attachment E - Survey of Ob-Gyns IRB Approval.pdf	05/04/2018
Email Invitation (Local Health Department)	Attachment J - LHD Survey Email Invitation.docx	05/04/2018
Email Reminder	Attachment K - LHD Survey Email Reminders.DOCX	05/04/2018
IRB Approval (Local Health Department)	Attachment L - LHD Survey IRB Approval.docx	05/04/2018
ACOG Focus Group IRB Approval	Attachment H - Focus Group IRB Approval.docx	05/04/2018
Supporting Statement A	Revised Supporting Statement A 04MAY2018.docx	05/04/2018
Supporting Statement B	Revised Supporting Statement B 04MAY2018.docx	05/04/2018

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