Zika Postpartum Emergency Response Survey (ZPER), Puerto Rico, 2017

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
ZPER Telephone Follow-up Questionnaire – Spanish phone version	Form and Instruction	New	Available
ZPER Telephone Follow-up Questionnaire – English phone version	Form and Instruction	New	Available
IN-HOSPITAL PARTNER SURVEY: Spanish version	Form and Instruction	New	Available
IN-HOSPITAL PARTNER SURVEY: English version	Form and Instruction	New	Available
IN-HOSPITAL MATERNAL SURVEY: Spanish version	Form and Instruction	New	Available
IN-HOSPITAL MATERNAL SURVEY: English version	Form and Instruction	New	Available
SSB - Emergency Zika Package ZPER_081717_DRH_clean.docx	Supporting Statement B	Uploaded 2017-08-18	Available
SSA - Emergency Zika Package ZPER_081717_DRH_clean.docx	Supporting Statement A	Uploaded 2017-08-18	Available
Att 10 Sampling ZPER Protocol_6_20_17.docx	Supplementary Document	Uploaded 2017-08-11	Available
Att 6 PRAMS IRB approval.docx	Supplementary Document	Uploaded 2017-08-11	Available
Att 5b Telephone Introductory Scripts and Consent_Spanish_062017.docx	Supplementary Document	Uploaded 2017-08-11	Available
Att 5a Telephone Introductory Scripts and Consent_English_062017.docx	Supplementary Document	Uploaded 2017-08-11	Available
Att 4bTelephone Survey Introductory Letter_Spanish_062017.docx	Supplementary Document	Uploaded 2017-08-11	Available
Att 4a Telephone Survey Introductory Letter_English_062017.docx	Supplementary Document	Uploaded 2017-08-11	Available
Att 3h - Hospital based FATHER-PARTNER ASSENT (SPANISH).doc	Supplementary Document	Uploaded 2017-08-11	Available
Att 3g - Hospital based FATHER-PARTNER ASSENT (ENGLISH).doc	Supplementary Document	Uploaded 2017-08-11	Available
Att 3f - Hospital based FATHER-PARTNER CONSENT (SPANISH).doc	Supplementary Document	Uploaded 2017-08-11	Available
Att 3e - Hospital based FATHER-PARTNER CONSENT (ENGLISH).doc	Supplementary Document	Uploaded 2017-08-11	Available
Att 3d - Hospital based MATERNAL ASSENT (SPANISH).doc	Supplementary Document	Uploaded 2017-08-11	Available
Att 3c - Hospital based MATERNAL ASSENT (ENGLISH).doc	Supplementary Document	Uploaded 2017-08-11	Available
Att 3b - Hospital based MATERNAL CONSENT (SPANISH).doc	Supplementary Document	Uploaded 2017-08-11	Available
Att 3a - Hospital based MATERNAL CONSENT (ENGLISH).doc	Supplementary Document	Uploaded 2017-08-11	Available
Att 2 - 60-Day FRN.pdf	Supplementary Document	Uploaded 2017-08-08	Available
Att 1 - Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2017-08-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227894	Telephone Follow-Up Survey	Form and Instruction	New	ZPER Telephone Follow-up Questionnaire – Spanish phone version
227894	Telephone Follow-Up Survey	Form and Instruction	New	ZPER Telephone Follow-up Questionnaire – English phone version
227893	Hospital-based Survey for Fathers/Partners	Form and Instruction	New	IN-HOSPITAL PARTNER SURVEY: Spanish version
227893	Hospital-based Survey for Fathers/Partners	Form and Instruction	New	IN-HOSPITAL PARTNER SURVEY: English version
227892	Hospital-based Survey for Mothers	Form and Instruction	New	IN-HOSPITAL MATERNAL SURVEY: Spanish version
227892	Hospital-based Survey for Mothers	Form and Instruction	New	IN-HOSPITAL MATERNAL SURVEY: English version

ICR Details

OMB Control No: 0920-1199	ICR Reference No: 201708-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-17ABC
Title: Zika Postpartum Emergency Response Survey (ZPER), Puerto Rico, 2017
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/25/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/18/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2018	12 Months From Approved
Responses	7,850	0	0
Time Burden (Hours)	2,462	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The ZPER study will assess utilization of Zika virus prevention strategies and resource needs of pregnant and postpartum women, and newborn infants in Puerto Rico. A hospital-based survey of mothers and fathers will obtain information on the prenatal period. A follow-up telephone survey period will assess ongoing needs of mothers and infants in the postpartum period. The study will continue to collect data that was initially approved as 0920-1183 in May 2017 as an Emergency collection. Data will be used to inform the Puerto Rico Department of Health about the need for social services targeting postpartum women and infants.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: U.S. Public Health Service Act
  

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 18464	04/19/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 39438	08/18/2017
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
Hospital-based Survey for Fathers/Partners	NA, NA	IN-HOSPITAL PARTNER SURVEY: English version ,   IN-HOSPITAL PARTNER SURVEY: Spanish version
Hospital-based Survey for Mothers	NA, NA	IN-HOSPITAL MATERNAL SURVEY: English version ,   IN-HOSPITAL MATERNAL SURVEY: Spanish version
Telephone Follow-Up Survey	NA, NA	ZPER Telephone Follow-up Questionnaire – English phone version ,   ZPER Telephone Follow-up Questionnaire – Spanish phone version

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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	7,850	0	0	7,850	0	0
Annual Time Burden (Hours)	2,462	0	0	2,462	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 0920-17AYP is a New ICR. It is intended to continue collection of data from a previously approved ZPER study related to the Zika Virus outbreak.

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Annual Cost to Federal Government: $400,587

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.     Yes

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.     Yes

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: 08/18/2017

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