OMB control number

Monitoring & Evaluation for the Zika Contraception Access Network (Z-CAN)

OMB 0920-1164 · HHS/CDC.

OMB 0920-1164

Latest Forms, Documents, and Supporting Material

Document Name
Online Survey - 12 month Follow-Up - Patients 18 years or older Form and Instruction
Online Survey - 6 month Follow-Up - Patients 18 years or older Form and Instruction
Online Survey - Z-CAN Staff Form and Instruction
Online Survey - Z-CAN Physician Form and Instruction
Semi-structured Individual Interview - Z-CAN Staff Form and Instruction
Semi-structured Individual Interview - Z-CAN Physicians Form and Instruction
Focus Group Guide - Women 18 years or older / able to conceive Form and Instruction
Focus Group Screener - Women 18 years or older / able to conceive Form and Instruction
Emergency Review Request Memo - Final.pdf Supplementary Document
09-20-0136 57FR62812 SORN.txt Supplementary Document
Att Q Consent_Online Survey_ZCAN women.docx Supplementary Document
Att P-4 Invitation_Online Survey_ZCAN women (Span).docx Supplementary Document
Att P-3 Invitation_Online Survey_ZCAN women (Eng).docx Supplementary Document
Att P-2 Interim contact_Online Survey_ZCAN women (Span).docx Supplementary Document
Att P-1 Interim contact_Online Survey_ZCAN women (Eng).docx Supplementary Document
Att O-2 2 week survey NRD_amended.pdf Supplementary Document
Att O-1 2 week survey NRD.pdf Supplementary Document
Att M-2 Consent_Online Survey_Staff.docx Supplementary Document
Att M-1 Consent_Online Survey_Physicians.docx Supplementary Document
Att L-4 Invitation_Survey_Staff (Span).docx Supplementary Document
Att L-3 Invitation_Survey_Staff (Eng).docx Supplementary Document
Att L-2 Invitation_Survey_Physicians (Span).docx Supplementary Document
Att L-1 Invitation_Survey_Physicians (Eng).docx Supplementary Document
Att J-2 Consent_Interview_Staff.docx Supplementary Document
Att J-1 Consent_Interview_Physicians.docx Supplementary Document
Att I-4 Invitation_Interview_Staff (Span).docx Supplementary Document
Att I-3 Invitation_Interview_Staff (Eng).docx Supplementary Document
Att I-2 Invitation_Interview_Physicians (Span).docx Supplementary Document
Att I-1 Invitation_Interview_Physicians (Eng).docx Supplementary Document
Att G Consent_FGD ZCAN women.docx Supplementary Document
Att E-2 Recruitment flyer (Span).pdf Supplementary Document
Att E-1 Recruitment flyer (Eng).docx Supplementary Document
Att D-2 UPR IRB approval_qual.pdf Supplementary Document
Att D-1 CDC IRB approval letter.pdf Supplementary Document
Att C Privacy Act Determination.pdf Supplementary Document
Att B 60-day FRN 1 25 2017.docx Supplementary Document
SSB_Emergency Zika_Z-CAN 07FEB2017.docx Supporting Statement B
SSA_Emergency Zika_Z-CAN 07FEB2017.docx Supporting Statement A
Att A-Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document
Online Survey - 12 month Follow-Up - Patients 18 years or older Form and Instruction
Online Survey - 6 month Follow-Up - Patients 18 years or older Form and Instruction
Online Survey - Z-CAN Staff Form and Instruction
Online Survey - Z-CAN Physician Form and Instruction
Semi-structured Individual Interview - Z-CAN Staff Form and Instruction
Semi-structured Individual Interview - Z-CAN Physicians Form and Instruction
Focus Group Guide - Women 18 years or older / able to conceive Form and Instruction
Focus Group Screener - Women 18 years or older / able to conceive Form and Instruction

All Historical Document Collections

201702-0920-003

Approved with change

New collection (Request for a new OMB Control Number)

2017-02-09