Assessment of Interventions Intended to Protect Pregnant Women in Puerto Rico from Zika virus Infections

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Follow-Up Telephone Interview	Form and Instruction	New	Repair queued
Initial Telephone Interview	Form and Instruction	New	Available
Pregnant Women in PR SSA_FINAL 01SEP2017.docx	Supporting Statement A	Uploaded 2017-09-01	Available
Statement B 2 MARCH 2017.docx	Supporting Statement B	Uploaded 2017-04-10	Available
Att. E - IRB.pdf	Supplementary Document	Uploaded 2017-03-07	Available
Att. F - Logic Model PR Activities.pdf	Supplementary Document	Uploaded 2017-03-07	Available
Att. B1 - Public comment.pdf	Supplementary Document	Uploaded 2017-03-07	Available
Att. B - 60-day FRN.pdf	Supplementary Document	Uploaded 2017-03-07	Available
Att. A - Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2017-03-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
225998	Follow-Up Telephone Interview	Form and Instruction	New
225997	Initial Telephone Interview	Form and Instruction	New

ICR Details

OMB Control No: 0920-1196	ICR Reference No: 201703-0920-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 17IX
Title: Assessment of Interventions Intended to Protect Pregnant Women in Puerto Rico from Zika virus Infections
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/01/2017
	Date Received in OIRA: 04/12/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2018	01/31/2018
Responses	1,800	0	0
Time Burden (Hours)	500	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The goal of this information collection is to assess the delivery and effects of interventions implemented in Puerto Rico to protect pregnant women from Zika virus infections and the birth defects that Zika virus can cause their babies. Information will be collected via telephone interviews with pregnant women living in Puerto Rico enrolled in the federal supplemental nutrition program for Women, Infants, and Children. Information will be used to help refine interventions that have been conducted to prevent and control Zika virus in Puerto Rico and to assess which interventions reduce risk and/or offer protection from Zika virus infections.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: U.S. 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
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 96461	12/30/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 16835	04/06/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Initial Telephone Interview	NA, NA	Initial Telephone Interview - ENGLISH ,   Initial Telephone Interview - SPANISH
Follow-Up Telephone Interview	NA, NA	Follow-Up Telephone Interview - ENGLISH ,   Follow-Up Telephone Interview - SPANISH

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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	1,800	0	0	1,800	0	0
Annual Time Burden (Hours)	500	0	0	500	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: Submission of 0920-17IX is an Existing Collection in Use Without an OMB Control Number. It is a request to complete a project previously approved under an Emergency Clearance (0920-1118).

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Annual Cost to Federal Government: $52,575

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 04/12/2017

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