Zika Reproductive Health and Emergency Response Call-Back Survey, 2018

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Survey and Consent - Zika Reproductive Health and Emergency Response Call-Back Survey (ZRHER), 2018	Form and Instruction	Modified	Available
Recruitment Script - Zika Reproductive Health and Emergency Response Call-Back Survey (ZRHER), 2018	Form and Instruction	Modified	Available
0902-1223 Change Request Justification-5-24-2018.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-05-31	Available
SS A - BRFSS Zika and Emergency Response Call Back_1-9-2018_clean.docx	Supporting Statement A	Uploaded 2018-01-31	Available
rpt684_IRB_Form.pdf	Supplementary Document	Uploaded 2018-01-30	Available
Att 3 Source of questions for ZRHER_11-21-2017.docx	Supplementary Document	Uploaded 2018-01-30	Available
Att 2b Public Comment 60 day FRN - ZRHER.pdf	Supplementary Document	Uploaded 2018-01-30	Available
Att 2a 60d FRN - ZRHER.pdf	Supplementary Document	Uploaded 2018-01-30	Available
Att 1 Authorizing Legislation - Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2018-01-30	Available
SS B - BRFSS Zika and Emergency Response Call Back_12-10-2017_clean.docx	Supporting Statement B	Uploaded 2018-01-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
229888	Survey and Consent - Zika Reproductive Health and Emergency Response Call-Back Survey (ZRHER), 2018	Form and Instruction	Modified
229887	Recruitment Script - Zika Reproductive Health and Emergency Response Call-Back Survey (ZRHER), 2018	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-1223	ICR Reference No: 201805-0920-011
Status: Active	Previous ICR Reference No: 201712-0920-014
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-18KS
Title: Zika Reproductive Health and Emergency Response Call-Back Survey, 2018
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/05/2018
	Date Received in OIRA: 06/05/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	04/30/2021	04/30/2021
Responses	34,729	0	34,729
Time Burden (Hours)	2,034	0	2,034
Cost Burden (Dollars)	0	0	0

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Abstract: The Zika Reproductive Health and Emergency Response Call-Back Survey, (ZRHER) assess the extent to which women of reproductive age (18-49 years): are being screened for potential travel related exposure to infectious diseases, are knowledgeable about recommendations for pregnancy timing in regards to Zika exposure, and are prepared for public health emergencies, including natural disasters such as the recent hurricanes along the Gulf Coast and Caribbean. This collection has been developed to build upon similar collections that were approved for collection in Puerto Rico and is intended to help States improve their response planning for women of reproductive age that are susceptible to the negative impacts of public health emergencies, including adverse pregnancy outcomes. This Non-Substantive Change Request is being submitted for a Spanish version of the survey and consent for states with substantial Spanish speaking populations. No change to the burden estimate is requested.

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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:
	83 FR 4056	01/29/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Recruitment Script - Zika Reproductive Health and Emergency Response Call-Back Survey (ZRHER), 2018	NA, NA	Recruitment Script - ZRHER ,   Recruitment Script - ZRHER Spanish
Survey and Consent - Zika Reproductive Health and Emergency Response Call-Back Survey (ZRHER), 2018	NA, NA	Survey and Consent - ZRHER ,   Survey and Consent - ZRHER Spanish

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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	34,729	34,729	0	0	0	0
Annual Time Burden (Hours)	2,034	2,034	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $23,426

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.     No

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: 06/05/2018

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