Information Collection

Infant Health Follow-Up Form - 2 Months of Age

IC 220151 under ICR 201602-0920-005 · OMB 0920-1101.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1101 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Infant Health Follow-Up Form - 2 Months of Age	Form and Instruction
Pregnancy and Zika Virus Disease Surveillance Form - Inf Att. G -- Infant Follow-Up Form.pdf	Form and Instruction

IC Title:

Infant Health Follow-Up Form - 2 Months of Age

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Pregnancy and Zika Virus Disease Surveillance Form - Infant Follow-Up	Att. G -- Infant Follow-Up Form.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136 - Epidemiological Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.