Zika Reproductive Health Call-Back Survey (ZRHCS), PUERTO RICO 2017

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Call Back Survey Data	Form and Instruction	New	Available
Recruitment Script Data	Form and Instruction	New	Available
Zika Reproductive Health Call-Back Survey (ZRHCS) - Puerto Rico, 2017 Call Back Survey	Form and Instruction	New	Available
Zika Reproductive Health Call-Back Survey (ZRHCS), 2017 - Recruitment Script	Form and Instruction	New	Available
60d FRN - ZRHCS 27APR2017.pdf	Supplementary Document	Uploaded 2017-07-07	Available
SSB - BRFSS PR ZIka Call Back 6-26-2017_clean.docx	Supporting Statement B	Uploaded 2017-07-07	Available
SSA - BRFSS PR Zika Call back_6-26-2017_clean.docx	Supporting Statement A	Uploaded 2017-07-07	Available
Att 6 Non-research determination.pdf	Supplementary Document	Uploaded 2017-04-26	Available
Att 2 BRFSS Jurisdictions at High Risk for Zika Cases_3-23-2017.docx	Supplementary Document	Uploaded 2017-04-26	Available
Att 1 Authorizing Legislation - Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2017-04-26	Available
request memo Bauer.pdf	Supplementary Document	Uploaded 2017-04-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227416	Puerto Rico BRFSS Coordinator - Data submission	Form and Instruction	New	Call Back Survey Data
227416	Puerto Rico BRFSS Coordinator - Data submission	Form and Instruction	New	Recruitment Script Data
227415	Zika Reproductive Health Call-Back Survey (ZRHCS) - Puerto Rico, 2017 Call Back Survey	Form and Instruction	New	Zika Reproductive Health Call-Back Survey (ZRHCS) - Puerto Rico, 2017 Call Back Survey
227414	Zika Reproductive Health Call-Back Survey (ZRHCS) - Puerto Rico, 2017 Recruitment Script	Form and Instruction	New	Zika Reproductive Health Call-Back Survey (ZRHCS), 2017 - Recruitment Script

ICR Details

OMB Control No: 0920-1188	ICR Reference No: 201704-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 17ABU
Title: Zika Reproductive Health Call-Back Survey (ZRHCS), PUERTO RICO 2017
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 07/10/2017
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/07/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/07/2017
Terms of Clearance: Approved consistent with the understanding that this collection is anticipated to extend beyond the 90 day emergency clearance. CDC will subsequently submit to OMB an ICR for standard review before the expiration of this emergency clearance period to permit continuation of this collection.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	6 Months From Approved
Responses	2,888	0	0
Time Burden (Hours)	241	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: To assess, on a population-level, the current utilization of Zika prevention strategies targeted at women of reproductive age (18-49 years) in Puerto Rico, and determine the need for further refinements in educational messaging and allocation of resources, as established during the first season of the Zika outbreak.

Emergency Justfication: CDC seeks Emergency Clearance, as new outbreaks and an increased number of Zika cases are expected as the summer travel and mosquito season approaches. A delayed start to this study would mean that critical information on; 1) the use of contraception among women wishing to avoid or delay pregnancies, 2) the barriers to access and use of contraception, 3) knowledge of and adherence to mosquito prevention strategies, and 4) frequency of travel to areas with Zika transmission and adherence to travel recommendations, would not be able to be gathered.

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Authorizing Statute(s): US Code: 43 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:
	82 FR 19370	04/27/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Puerto Rico BRFSS Coordinator - Data submission	NA, NA	Recruitment Script Data ,   Call Back Survey Data
Zika Reproductive Health Call-Back Survey (ZRHCS) - Puerto Rico, 2017 Call Back Survey	NA	Zika Reproductive Health Call-Back Survey (ZRHCS) - Puerto Rico, 2017 Call Back Survey
Zika Reproductive Health Call-Back Survey (ZRHCS) - Puerto Rico, 2017 Recruitment Script	NA	Zika Reproductive Health Call-Back Survey (ZRHCS), 2017 - Recruitment Script

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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	2,888	0	0	2,888	0	0
Annual Time Burden (Hours)	241	0	0	241	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 0920-17ABU is a New Emergency Clearance Request related to the Zika Virus outbreak in Puerto Rico.

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Annual Cost to Federal Government: $25,502

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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: 07/07/2017

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