OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Zika Postpartum Emergency Response Survey (ZPER), Puerto Rico, 2017

OMB 0920-1199 ยท HHS/CDC.

OMB 0920-1199

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 0920-1199 Telephone Follow-Up Survey (New Version)Form and Instruction
Telephone Follow-Up SurveyForm and Instruction
Hospital-based Survey for Fathers/PartnersForm and Instruction
Hospital-based Survey for MothersForm and Instruction
PRAMS-ZPER (1199) Change Request_122117docx_Clean.docx Justification for No Material/Nonsubstantive Change
SSB - Emergency Zika Package ZPER_081717_DRH_clean.docxSupporting Statement B
SSA - Emergency Zika Package ZPER_081717_DRH_clean.docxSupporting Statement A
Att 10 Sampling ZPER Protocol_6_20_17.docx Supplementary Document
Att 6 PRAMS IRB approval.docx Supplementary Document
Att 5b Telephone Introductory Scripts and Consent_Spanish_062017.docx Supplementary Document
Att 5a Telephone Introductory Scripts and Consent_English_062017.docx Supplementary Document
Att 4bTelephone Survey Introductory Letter_Spanish_062017.docx Supplementary Document
Att 4a Telephone Survey Introductory Letter_English_062017.docx Supplementary Document
Att 3h - Hospital based FATHER-PARTNER ASSENT (SPANISH).doc Supplementary Document
Att 3g - Hospital based FATHER-PARTNER ASSENT (ENGLISH).doc Supplementary Document
Att 3f - Hospital based FATHER-PARTNER CONSENT (SPANISH).doc Supplementary Document
Att 3e - Hospital based FATHER-PARTNER CONSENT (ENGLISH).doc Supplementary Document
Att 3d - Hospital based MATERNAL ASSENT (SPANISH).doc Supplementary Document
Att 3c - Hospital based MATERNAL ASSENT (ENGLISH).doc Supplementary Document
Att 3b - Hospital based MATERNAL CONSENT (SPANISH).doc Supplementary Document
Att 3a - Hospital based MATERNAL CONSENT (ENGLISH).doc Supplementary Document
Att 2 - 60-Day FRN.pdf Supplementary Document
Att 1 - Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document
Telephone Follow-Up Survey (New Version) Form and Instruction
Telephone Follow-Up Survey Form and Instruction
Hospital-based Survey for Fathers/Partners Form and Instruction
Hospital-based Survey for Mothers Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
201712-0920-013 No material or nonsubstantive change to a currently approved collection 2018-01-04 Approved without change
201708-0920-008 New collection (Request for a new OMB Control Number) 2017-08-18 Approved without change