Zika Reproductive Health Call-Back Survey (ZRHCS), Puerto Rico, 2017

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Puerto Rico BRFSS Coordinator Electronic Datas Submission Layout	Form	New	Available
Zika Reproductive Health Call-Back Survey (ZRHCS), Puerto Rico, 2017 - Survey and Consent	Form and Instruction	New	Available
Zika Reproductive Health Call-Back Survey (ZRHCS), Puerto Rico, 2017 - Recruitment Script	Form and Instruction	New	Available
Att 5 ZRHCS Non-research determination.pdf	Supplementary Document	Uploaded 2017-09-22	Available
Att 2b Public Comment 60 day FRN - ZRHCS.pdf	Supplementary Document	Uploaded 2017-09-22	Available
Att 2a 60d FRN - ZRHCS 27APR2017.pdf	Supplementary Document	Uploaded 2017-09-22	Available
Att 1 Authorizing Legislation - Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2017-09-22	Available
SSB - BRFSS PR Zika Call back_9-7-2017_clean.docx	Supporting Statement B	Uploaded 2017-09-22	Available
SSA - BRFSS PR Zika Call back_8-11-2017.docx	Supporting Statement A	Uploaded 2017-09-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
228476	Data Submission Layout - PRA BRFSS Coordinators	Form	New	Puerto Rico BRFSS Coordinator Electronic Datas Submission Layout
228432	Call-back Survey and Consent	Form and Instruction	New	Zika Reproductive Health Call-Back Survey (ZRHCS), Puerto Rico, 2017 - Survey and Consent
228431	Recruitment Script	Form and Instruction	New	Zika Reproductive Health Call-Back Survey (ZRHCS), Puerto Rico, 2017 - Recruitment Script

ICR Details

OMB Control No: 0920-1212	ICR Reference No: 201708-0920-024
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-17ABU
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: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/22/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/28/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2018	12 Months From Approved
Responses	1,229	0	0
Time Burden (Hours)	117	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This study will continue collection of information approved by OMB under the Emergency ICR “Emergency Zika Package: Zika Reproductive Health Survey, Puerto Rico, 2017” (OMB Control No. 0920-1188). It will assess 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. Information collected will be compared to 2016 survey data (OMB Control No. 0920-1114) to inform and evaluate Zika emergency response planning in Puerto Rico.

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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:
	82 FR 19370	04/27/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 43990	09/20/2017
Did the Agency receive public comments on this ICR? Yes

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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
Call-back Survey and Consent	NA	Zika Reproductive Health Call-Back Survey (ZRHCS), Puerto Rico, 2017 - Survey and Consent
Data Submission Layout - PRA BRFSS Coordinators	NA	Puerto Rico BRFSS Coordinator Electronic Datas Submission Layout
Recruitment Script	NA	Zika Reproductive Health Call-Back Survey (ZRHCS), Puerto Rico, 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	1,229	0	0	1,229	0	0
Annual Time Burden (Hours)	117	0	0	117	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: 0920-17ABU is a New ICR being submitted to continue collection of Zika-related information initially approved under an Emergency Clearance.

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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

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.     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: 09/28/2017

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