Zika Reproductive Health Call-Back Survey (ZRHCS), Puert

Attachment 3

Zika Reproductive Health Call-Back Survey

(ZRHCS), Puerto Rico, 2017

Recruitment Script

“We would like to call to you again to talk in more detail about reproductive issues related to the Zika virus.

The information will be used to help develop and improve the response to the Zika virus in <STATE>. The information you gave us today and any you give us in the future will be kept confidential.

If you agree to this, we will keep your first name or initials and phone number on file, separate from the answers collected today.

Even if you agree now, you may refuse to participate in the future. Would it be okay if we called you back to ask additional questions at a later time?”

1 Yes

2 No

Public reporting burden of this collection of information is estimated to average 1 minute per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).