Information Collection Request

Zika Virus RNA Persistence in Pregnant Women and Congenitally Exposed Infants in Puerto Rico (ZIRP)

ICR 201706-0920-003 · OMB 0920-1189 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Infant Follow-Up Questionnaire Form and Instruction New Available
Infant Enrollment and Delivery Questionnaire Form and Instruction New Available
Pregnant Women Follow-Up Questionnaire Form and Instruction New Available
Pregnant Women Symptom Questionnaire Form and Instruction New Available
Pregnant Women Enrollment Questionnaire Form and Instruction New Available
Pregnant Women Screening Form Form and Instruction New Available
OMB_Part B_ZIRP_full_v1_clean.docx Supporting Statement B Uploaded 2017-07-07 Available
OMB_Part A_ZIRP_full_v1_clean.docx Supporting Statement A Uploaded 2017-07-07 Available
Att E1- 7005 IRB Submission Approval.docx Supplementary Document Uploaded 2017-07-07 Available
Att D3 - Agreement to abide by data restrictions.docx Supplementary Document Uploaded 2017-07-07 Available
Att D2 - FTE Non-disclosure agreement.docx Supplementary Document Uploaded 2017-07-07 Available
Att D1 - Assurance of Confidentiality.docx Supplementary Document Uploaded 2017-07-07 Available
deb lubar signed memo.pdf Supplementary Document Uploaded 2017-07-07 Available
Att B - 60-day notice.pdf Supplementary Document Uploaded 2017-07-07 Available
Att A - Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document Uploaded 2017-07-07 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
227422 Infant Follow-Up Questionnaire Form and Instruction New
227421 Infant Enrollment and Delivery Questionnaire Form and Instruction New
227420 Pregnant Women Follow-Up Questionnaire Form and Instruction New
227419 Pregnant Women Symptom Questionnaire Form and Instruction New
227418 Pregnant Women Enrollment Questionnaire Form and Instruction New
227417 Pregnant Women Screening Form Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2017 6 Months From Approved
6,000 0 0
785 0 0
0 0 0





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 6,000 0 0 6,000 0 0
Annual Time Burden (Hours) 785 0 0 785 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No