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

OMB 0920-1223

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.

The latest form for Zika Reproductive Health and Emergency Response Call-Back Survey, 2018 expires 2021-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

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

All Historical Document Collections

201805-0920-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-06-05
201712-0920-014 Approved without change	New collection (Request for a new OMB Control Number)	2018-02-01

OMB Details

Recruitment Script - Zika Reproductive Health and Emergency Response Call-Back Survey (ZRHER), 2018

Federal Enterprise Architecture: Disaster Management - Disaster Preparedness and Planning

Form NA	Recruitment Script - ZRHER	NA	Form and instruction
Form NA	Recruitment Script - ZRHER Spanish	NA	Form and instruction

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