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FORMATIVE RESEARCH TO DEVELOP ZIKA TOOLS FOR HEALTHCARE PROVIDERS 0920-1154-18WU
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-1154 ACOG Zika Virus Survey Attachment A - Survey of Ob-Gyns Mailed.docx NA Yes Yes Fillable Fileable
Other-Focus Group Discussion Guide - OB-GYN/PEDS/MIDWIVES/NPs Attachment F - Focus Group Discussion Guide.docx NA No   Paper Only
Form and Instruction 0920-1154 Focus Group Recruitment Screen Attachment G - Focus Group Recruitment Screener.docx NA No   Paper Only
Form and Instruction 0920-1154 ACOG Evaluation of Local Health Department Initiative Attachment I - LHD Survey.docx NA Yes Yes Fillable Fileable

Health Illness Prevention

 

4,422 0
   
Private Sector Businesses or other for-profits
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,422 0 4,422 0 0 0
Annual IC Time Burden (Hours) 835 0 835 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Email Invitation (OB-GYN) Attachment B - Survey of Ob-Gyns Email Invitation.docx 05/04/2018
Email Reminder (OB-GYN) Attachment C - Survey of Ob-Gyns Email Reminders.docx 05/04/2018
Cover Letter Invitation Attachment D - Survey of Ob-Gyns Mailing Cover Letter.docx 05/04/2018
IRB Approval Attachment E - Survey of Ob-Gyns IRB Approval.pdf 05/04/2018
Email Invitation (Local Health Department) Attachment J - LHD Survey Email Invitation.docx 05/04/2018
Email Reminder Attachment K - LHD Survey Email Reminders.DOCX 05/04/2018
IRB Approval (Local Health Department) Attachment L - LHD Survey IRB Approval.docx 05/04/2018
ACOG Focus Group IRB Approval Attachment H - Focus Group IRB Approval.docx 05/04/2018
Supporting Statement A Revised Supporting Statement A 04MAY2018.docx 05/04/2018
Supporting Statement B Revised Supporting Statement B 04MAY2018.docx 05/04/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.