Knowledge, Attitudes, and Practices related to a Domestic Readiness Initiative on Zika Virus Disease

Forms and Documents

Document Name	Status
Zika Readiness Initiative Survey (U.S. Domestic/Puerto Rico Adults) Form and Instruction	New
RE request for researchnon-research determination .msg Supplementary Document	2017-08-03
Attachment H - Script for incoming calls 2 _5_17.docx Supplementary Document	2017-08-03
Attachment G - Zika Readiness Voicemail Message 2_15_17.docx Supplementary Document	2017-08-03
Attachment A - Public Health Service Act (42 USC 241) Section 301 2_15_17.pdf Supplementary Document	2017-08-03
2017-05933.pdf Supplementary Document	2017-08-03
Zika Readiness OMB Supporting Statement B_OMB 2_15_17_revised_clean.docx Supporting Statement B	2017-08-03
Zika Readiness OMB Supporting Statement A_ OMB 2_15_17_revised_9_6_2017_clean.docx Supporting Statement A	2017-09-07

IC Document Collections

IC ID	Document Title	Status
227798	Zika Readiness Initiative Survey (U.S. Domestic/Puerto Rico Adults) Form and Instruction	New

ICR Details

OMB Control No: 0920-1197	ICR Reference No: 201707-0920-012
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-17WE
Title: Knowledge, Attitudes, and Practices related to a Domestic Readiness Initiative on Zika Virus Disease
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/11/2017
	Date Received in OIRA: 08/07/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2018	36 Months From Approved
Responses	2,400	0	0
Time Burden (Hours)	560	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this data collection is to conduct the final wave of an evaluation survey to assess CDC's communication and education effort to prepare and protect populations at risk of contracting the Zika virus in the domestic U.S and Puerto Rico. This data collection request includes a single, cross-sectional survey to assess current attitudes, beliefs and behaviors related to CDC's Zika Domestic Readiness campaign.

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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 15222	03/27/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 36147	08/03/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Zika Readiness Initiative Survey (U.S. Domestic/Puerto Rico Adults)	NA	Zika Readiness Initiative Questionnaire (U.S./Puerto Rico)

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ICR Summary 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	2,400	0	0	2,400	0	0
Annual Time Burden (Hours)	560	0	0	560	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: No

Burden Reduction Due to:

Short Statement: Submission of 0920-17WE - Knowledge, Attitudes, and Practices related to a Domestic Readiness Initiative on Zika Virus Disease is a request for approval of a New ICR related to the Zika Virus outbreak.

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Annual Cost to Federal Government: $36,461

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: 08/07/2017

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