OMB control number

ZEN Colombia Study: Zika in Pregnant Women and Children in Colombia

OMB 0920-1190 · HHS/CDC.

OMB 0920-1190

Multiple projects have been jointly developed between INS and CDC, including enhanced surveillance of pregnant women with symptomatic Zika virus disease. CDC seeks to implement a prospective cohort study in which we will follow women enrolled in the first trimester of pregnancy, their male partners, and their children in several cities in Colombia in which ZIKV transmission is currently ongoing. This is a continuation study to collect data on the OMB-approved Emergency Clearance package 0920-1142, and the Standard ICR 0920-1190. This request for non-substantive change modifies some inclusion/exclusion criteria, a few questions, and permission for video recording.

The latest form for ZEN Colombia Study: Zika in Pregnant Women and Children in Colombia expires 2021-02-28 and is listed under ICR 201803-0920-014.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Parent Child Followup Questionnaire - Spanish	Form
Parent Child Followup Questionnaire	Form
Parent Child Enrollment Questionnaire - Spanish	Form and Instruction
Parent Child Enrollment Questionnaire	Form and Instruction
Parent Child Follow-up Eligibility Form - Spanish	Form
Parent Child Follow-up Eligibility Form	Form
Standardized Infant Assessments	Form
Center for Epidemiologic Studiesd Depression Scale	Form
Standardized Infant Assessments	Form
Standardized Infant Assessments	Form
Strengths and Difficulties Assessment - SPANISH	Form
Strengths and Difficulties Assessment - ENGLISH	Form
Ages and Stages Questionnaire - 24 month Spanish	Form and Instruction
Ages and Stages Questionnaire - 24 month English	Form and Instruction
Ages and Stages Questionnaire - 12 month Spanish	Form and Instruction
Ages and Stages Questionnaire - 12 month English	Form and Instruction
Ages and Stages Questionnaire - 24 month Spanish	Form and Instruction
Ages and Stages Questionnaire - 24 month English	Form and Instruction
Ages and Stages Questionnaire - 2 month Spanish	Form and Instruction
Ages and Stages Questionnaire - 2 month English	Form and Instruction
ZEN Colombia: Adult Symptoms - Spanish	Form
ZEN Columbia - Adult Symptoms Questionnaire - English	Form and Instruction
ZEN Columbia: Male Partner Enrollment Questionnaire - Spanish 08SEP2017	Form and Instruction
ZEN Columbia - Male Partner Enrollment Questionnaire - English 26MAY2017	Form and Instruction
ZEN Colombia : Male Partner Eligibility - Spanish	Form
ZEN Columbia - Male Partner Eligibility - English 26MAY2017	Form and Instruction
ZEN Columbia: Infant Symptoms - Spanish 08SEP2017	Form
ZEN Colombia: Infant Symptoms - English	Form
ZEN Columbia: Pregnant Women Follow-Up Questionnaire - Spanish 08SEP2017	Form and Instruction
ZEN Columbia: Pregnant Women Follow-Up Questionnaire - English 08SEP2017	Form and Instruction
ZEN Colombia: Adult Symptoms - Spanish	Form
ZEN Columbia - Adult Symptoms Questionnaire - English	Form and Instruction
ZEN Columbia: Pregnant Women Enrollment Questionnaire - Spanish 08SEP2017	Form and Instruction
ZEN Columbia - Pregnant Woman Enrollment Questionnaire - English 26MAY2017	Form and Instruction
ZEN Columbia: Pregnant Women Eligibility - Spanish 08SEP2017	Form and Instruction
ZEN Columbia: Pregnant Women Eligibility - English 08SEP2017	Form and Instruction
0920-1190_Change_Request_Justification_23MAR2018.docx	Justification for No Material/Nonsubstantive Change
Att D5_Parent_and_Child_Permission_Form_19JAN2018_clean.docx	Supplementary Document
6921 Amendment #7 approval.docx	Supplementary Document
60d FRN 2017-18405.pdf	Supplementary Document
0920-1190_Change_Request_Justification_092717 JZ.docx	Justification for No Material/Nonsubstantive Change
0920-1190_Change_Request_Justification_090617_submit.docx	Justification for No Material/Nonsubstantive Change
0920-17ABB_Change_Request_Justification_06JUL17.docx	Justification for No Material/Nonsubstantive Change
OMB_Part A_ZEN_full_15MAR2018_clean.docx	Supporting Statement A
OMB_Part B_ZEN_full_15MAR2018_clean.docx	Supporting Statement B
ATT_E3_6921 Vysnova relying on CDC.PDF	Supplementary Document
ATT_E2_INS_ethics_approval_ZEN_English_12122016.docx	Supplementary Document
Att_E1_6921_IRB_Amendment #3 approval.docx	Supplementary Document
ATT_D3_Infant Permission Form 030117_CLEAN.docx	Supplementary Document
ATT_D2_Male Participant Informed Consent 022217_CLEAN.docx	Supplementary Document
ATT_D1_Pregnant Woman Informed Consent 03012017_CLEAN.docx	Supplementary Document
Att_F2_FTE Nondisclosure.DOCX	Supplementary Document
Att_F3_Agreement to abide by restrictions.docx	Supplementary Document
Att_F1_Assurance of Confidentiality Zika Surveillance Final.doc	Supplementary Document
Att_A_Section 301 of Public Health Service Act (42 U.S.C. 241).docx	Supplementary Document
Parent-Child Follow-Up Questionnaire	Form
Parent-Child Follow-Up Questionnaire	Form
Parent-Child Enrollment Questionnaire	Form and Instruction
Parent-Child Enrollment Questionnaire	Form and Instruction
Parent-Child Eligibility Questionnaire	Form
Parent-Child Eligibility Questionnaire	Form
Test of Nonverbal Intelligence	Form
Center for Epidemiologic Studies Depression Scale	Form
Parenting Stress Index IV	Form
Peabody Developmental Motor Scales	Form
Strengths and Difficulties Questionnaire	Form
Strengths and Difficulties Questionnaire	Form
Bayley Scales of Infant and Toddler Development	Instruction
Pregnant Women - Ages and Stages: 12 and 24 Month Questionnaire	Form and Instruction
Pregnant Women - Ages and Stages: 12 and 24 Month Questionnaire	Form and Instruction
Pregnant Women - Ages and Stages: 12 and 24 Month Questionnaire	Form and Instruction
Pregnant Women - Ages and Stages: 12 and 24 Month Questionnaire	Form and Instruction
Pregnant Women - Ages and Stages 2 and 24 Month Questionnaire	Form and Instruction
Pregnant Women - Ages and Stages 2 and 24 Month Questionnaire	Form and Instruction
Pregnant Women - Ages and Stages 2 and 24 Month Questionnaire	Form and Instruction
Pregnant Women - Ages and Stages 2 and 24 Month Questionnaire	Form and Instruction
Male Partners - Adult Symptoms Questionnaire	Form
Male Partners - Adult Symptoms Questionnaire	Form and Instruction
Male Partners - Male Enrollment Questionnaire	Form and Instruction
Male Partners - Male Enrollment Questionnaire	Form and Instruction
Male Partners - Male Partner Eligibility Questionnaire	Form
Male Partners - Male Partner Eligibility Questionnaire	Form and Instruction
Pregnant Women - Infant Symptoms Questionnaire	Form
Pregnant Women - Infant Symptoms Questionnaire	Form
Pregnant Women - Pregnant Women Follow-Up Questionnaire	Form and Instruction
Pregnant Women - Pregnant Women Follow-Up Questionnaire	Form and Instruction
Pregnant Women - Adult Symptoms Questionnaire	Form
Pregnant Women - Adult Symptoms Questionnaire	Form and Instruction
Pregnant Women - Pregnant Women Enrollment Questionnaire	Form and Instruction
Pregnant Women - Pregnant Women Enrollment Questionnaire	Form and Instruction
Pregnant Women - Pregnant Women Eligibility Questionnaire	Form and Instruction
Pregnant Women - Pregnant Women Eligibility Questionnaire	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
201803-0920-014	No material or nonsubstantive change to a currently approved collection	2018-03-27	Approved without change
201710-0920-013	Revision of a currently approved collection	2017-11-30	Approved without change
201710-0920-001	No material or nonsubstantive change to a currently approved collection	2017-10-05	Approved without change
201709-0920-001	No material or nonsubstantive change to a currently approved collection	2017-09-08	Approved without change
201707-0920-008	No material or nonsubstantive change to a currently approved collection	2017-07-19	Approved without change
201703-0920-014	New collection (Request for a new OMB Control Number)	2017-04-20	Approved with change

OMB Details

Pregnant Women - Pregnant Women Eligibility Questionnaire

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
Form	Name	Electronic access	Type
Form NA	ZEN Columbia: Pregnant Women Eligibility - Spanish 08SEP2017	NA	Form and instruction
Form NA	ZEN Columbia: Pregnant Women Eligibility - English 08SEP2017	NA	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.