Communities Organized to Prevent Arboviruses: Assessment of Knowledge, Attitudes, and Vector Control Practices and Sero-Prevalence and Incidence of Arborviral Infection in Ponce, Puerto Rico (COPA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1254 COVID-19 Case Follow-Up Questionnaire	Form and Instruction	New	Available
Form 0920-1254 COVID-19 Case Follow-Up Questionnaire	Form and Instruction	New	Repair queued
Form 0920-1254 AIS Questionnaire - Data Collection Instruments (combined English/Spanish)	Form and Instruction	New	Available
Form 0920-1254 AIS Questionnaire	Form and Instruction	New	Repair queued
Form 0920-1254 AIS Text Message - Data Collection Instruments (combined English/Spanish)	Form and Instruction	New	Available
Form 0920-1254 AIS Text Message	Form and Instruction	New	Repair queued
Form 0920-1254 Mobility Questionnaire - Data Collection Instruments (combined English/Spanish)	Form and Instruction	New	Available
Form 0920-1254 Mobility Questionnaire	Form and Instruction	New	Repair queued
Form 0920-1254 Specimen Collection - Data Collection Instruments (combined English/Spanish)	Form and Instruction	Modified	Available
Form 0920-18ANU Specimen Lab Form	Form and Instruction	Modified	Available
Form 0920-18ANU Specimen Collection	Form and Instruction	Modified	Repair queued
Form 0920-1254 Vector Control Questionnaire - Data Collection Instruments (combined English/Spanish)	Form and Instruction	Modified	Available
Form 0920-18ANU Spanish Vector Control Questionnaire	Form and Instruction	Modified	Available
Form 0920-18ANU Vector Control Questionnaire	Form and Instruction	Modified	Available
Form 0920-18ANU Vector Control Intervention Questionnaire	Form and Instruction	Modified	Repair queued
Form 0920-1254 Knowledge, Attitudes and Practices (KAP) Questionnaire - Data Collection Instruments (combined English/Spanish)	Form and Instruction	Modified	Available
Form 0920-18ANU Year Two Combined Questionnaire	Form and Instruction	Modified	Available
Form 0920-18ANU Spanish KAP Younger Child	Form and Instruction	Modified	Available
Form 0920-18ANU Spanish KAP Older Child	Form and Instruction	Modified	Available
Form 0920-18ANU Spanish KAP Adult	Form and Instruction	Modified	Available
Form 0920-18ANU KAP Younger Child	Form and Instruction	Modified	Available
Form 0920-18ANU KAP Older Child	Form and Instruction	Modified	Available
Form 0920-18ANU KAP Adult	Form and Instruction	Modified	Available
Form 0920-18ANU Knowledge, Attitudes, and Practices Individual Questionnaire	Form and Instruction	Modified	Repair queued
Form 0920-1254 Individual Questionnaire - Data Collection Instruments (combined English/Spanish)	Form and Instruction	Modified	Available
Form 0920-18ANU Individual Questionnaire Spanish	Form and Instruction	Modified	Available
Form 0920-18ANU Individual Questionnaire	Form and Instruction	Modified	Available
Form 0920-18ANU Individual Questionnaire	Form and Instruction	Modified	Repair queued
Form 0920-1254 Household Representative Questionnaire - Data Collection Instruments (combined English/Spanish)	Form and Instruction	Modified	Available
Form 0920-18ANU Household Representative Questionnaire	Form and Instruction	Modified	Available
Form 0920-18ANU Household Representative Questionnaire	Form and Instruction	Modified	Repair queued
Attachment 8_COPA questionnaires dropped questions.pdf	Supplementary Document	Uploaded 2022-04-07	Repair queued
Attachment 6_Consent summary.pdf	Supplementary Document	Uploaded 2022-04-07	Repair queued
Attachment 2_Consent Forms - All Ages.pdf	Supplementary Document	Uploaded 2022-04-07	Repair queued
Attachment 7_IRB approval letter 171110-VR_IRB.pdf	Supplementary Document	Uploaded 2022-04-07	Repair queued
COPA Signed PIA.pdf	Supplementary Document	Uploaded 2022-04-07	Repair queued
Attachment 4_60 day FRN (2021-25449).pdf	Supplementary Document	Uploaded 2022-04-07	Repair queued
SSB COPA Revision 0920-1254.docx	Supporting Statement B	Uploaded 2022-04-07	Available
SSA COPA Revision 0920-1254.docx	Supporting Statement A	Uploaded 2022-04-07	Repair queued
10. COPA Flyer.pdf	Supplementary Document	Uploaded 2018-12-20	Repair queued
1. Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2018-12-20	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
252694	COVID-19 Case Follow-Up Questionnaire	Form and Instruction	New	COVID-19 Case Follow-Up Questionnaire
252694	COVID-19 Case Follow-Up Questionnaire	Form and Instruction	New
252691	AIS Questionnaire	Form and Instruction	New	AIS Questionnaire - Data Collection Instruments (combined English/Spanish)
252691	AIS Questionnaire	Form and Instruction	New
252686	AIS Text Message	Form and Instruction	New	AIS Text Message - Data Collection Instruments (combined English/Spanish)
252686	AIS Text Message	Form and Instruction	New
252684	Mobility Questionnaire	Form and Instruction	New	Mobility Questionnaire - Data Collection Instruments (combined English/Spanish)
252684	Mobility Questionnaire	Form and Instruction	New
234597	Specimen Collection	Form and Instruction	Modified	Specimen Collection - Data Collection Instruments (combined English/Spanish)
234597	Specimen Collection	Form and Instruction	Modified	Specimen Lab Form
234597	Specimen Collection	Form and Instruction	Modified
234596	Vector Control Intervention Questionnaire	Form and Instruction	Modified	Vector Control Questionnaire - Data Collection Instruments (combined English/Spanish)
234596	Vector Control Intervention Questionnaire	Form and Instruction	Modified	Spanish Vector Control Questionnaire
234596	Vector Control Intervention Questionnaire	Form and Instruction	Modified	Vector Control Questionnaire
234596	Vector Control Intervention Questionnaire	Form and Instruction	Modified
234595	Knowledge, Attitudes, and Practices Individual Questionnaire	Form and Instruction	Modified	Knowledge, Attitudes and Practices (KAP) Questionnaire - Data Collection Instruments (combined English/Spanish)
234595	Knowledge, Attitudes, and Practices Individual Questionnaire	Form and Instruction	Modified	Year Two Combined Questionnaire
234595	Knowledge, Attitudes, and Practices Individual Questionnaire	Form and Instruction	Modified	Spanish KAP Younger Child
234595	Knowledge, Attitudes, and Practices Individual Questionnaire	Form and Instruction	Modified	Spanish KAP Older Child
234595	Knowledge, Attitudes, and Practices Individual Questionnaire	Form and Instruction	Modified	Spanish KAP Adult
234595	Knowledge, Attitudes, and Practices Individual Questionnaire	Form and Instruction	Modified	KAP Younger Child
234595	Knowledge, Attitudes, and Practices Individual Questionnaire	Form and Instruction	Modified	KAP Older Child
234595	Knowledge, Attitudes, and Practices Individual Questionnaire	Form and Instruction	Modified	KAP Adult
234595	Knowledge, Attitudes, and Practices Individual Questionnaire	Form and Instruction	Modified
234594	Individual Questionnaire	Form and Instruction	Modified	Individual Questionnaire - Data Collection Instruments (combined English/Spanish)
234594	Individual Questionnaire	Form and Instruction	Modified	Individual Questionnaire Spanish
234594	Individual Questionnaire	Form and Instruction	Modified	Individual Questionnaire
234594	Individual Questionnaire	Form and Instruction	Modified
234590	Household Representative Questionnaire	Form and Instruction	Modified	Household Representative Questionnaire - Data Collection Instruments (combined English/Spanish)
234590	Household Representative Questionnaire	Form and Instruction	Modified	Household Representative Questionnaire
234590	Household Representative Questionnaire	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-1254	ICR Reference No: 202204-0920-005
Status: Historical Active	Previous ICR Reference No: 201812-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1254
Title: Communities Organized to Prevent Arboviruses: Assessment of Knowledge, Attitudes, and Vector Control Practices and Sero-Prevalence and Incidence of Arborviral Infection in Ponce, Puerto Rico (COPA)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/17/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/08/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2026	36 Months From Approved
Responses	72,145	0	0
Time Burden (Hours)	4,349	0	0
Cost Burden (Dollars)	36,970	0	0

---

Abstract: The purpose of this project is to establish longitudinal follow-up of a community cohort and evaluate the impact of vector control interventions in 14 clusters in southern Puerto Rico. The investigators have prior experience working in these communities; however, there is minimal available information regarding the prevalence or incidence of infection with tropical arboviruses, density of Ae. aegypti mosquitoes, or cluster members’ knowledge, attitudes, and practices regarding behaviors intended to avoid mosquitoes. Such information will be needed to inform decision-making regarding the location, design, and content of interventions to be implemented and evaluated to reduce the burden of these pathogens. This Reinstatement includes updated estimates for the number of respondents based on participation rates in the most recent year. We also request OMB approval for changes to the content of all four questionnaires and for the addition of the AIS text messaging system, the AIS questionnaire, and the COVID-19 case follow up questionnaire. Burden to respondents will increase by 838 hours per year.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 66311	11/22/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 20863	04/08/2022
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
AIS Questionnaire	0920-1254	AIS Questionnaire - Data Collection Instruments (combined English/Spanish)
AIS Text Message	0920-1254	AIS Text Message - Data Collection Instruments (combined English/Spanish)
COVID-19 Case Follow-Up Questionnaire	0920-1254	COVID-19 Case Follow-Up Questionnaire
Household Representative Questionnaire	0920-18ANU, 0920-1254	Household Representative Questionnaire ,   Household Representative Questionnaire - Data Collection Instruments (combined English/Spanish)
Individual Questionnaire	0920-18ANU, 0920-18ANU, 0920-1254	Individual Questionnaire ,   Individual Questionnaire Spanish ,   Individual Questionnaire - Data Collection Instruments (combined English/Spanish)
Knowledge, Attitudes, and Practices Individual Questionnaire	0920-18ANU, 0920-18ANU, 0920-18ANU, 0920-18ANU, 0920-18ANU, 0920-18ANU, 0920-18ANU, 0920-1254	KAP Adult ,   KAP Older Child ,   KAP Younger Child ,   Spanish KAP Adult ,   Spanish KAP Older Child ,   Spanish KAP Younger Child ,   Year Two Combined Questionnaire ,   Knowledge, Attitudes and Practices (KAP) Questionnaire - Data Collection Instruments (combined English/Spanish)
Mobility Questionnaire	0920-1254	Mobility Questionnaire - Data Collection Instruments (combined English/Spanish)
Specimen Collection	0920-18ANU, 0920-1254	Specimen Lab Form ,   Specimen Collection - Data Collection Instruments (combined English/Spanish)
Vector Control Intervention Questionnaire	0920-18ANU, 0920-18ANU, 0920-1254	Vector Control Questionnaire ,   Spanish Vector Control Questionnaire ,   Vector Control Questionnaire - Data Collection Instruments (combined English/Spanish)

---

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	72,145	0	0	56,025	0	16,120
Annual Time Burden (Hours)	4,349	0	0	878	0	3,471
Annual Cost Burden (Dollars)	36,970	0	0	11,804	0	25,166

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Reinstatement with Change for 0920-1254 includes revisions to existing data collection instruments, and addition of new data collection instruments to the previously approved collection. Total burden increases by 838 burden hours.

---

Annual Cost to Federal Government: $2,073,176

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? No

---

Common Form ICR:  No

---

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: 04/08/2022

---