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pdfForm Approved
OMB Control No.: 0920-XXXX
Exp. date: XX/XX/XXXX
CDC survey of county-level surveillance records of Aedes aegypti and
Aedes albopictus from 2000 to present
In response to the ongoing Zika virus outbreak, the Centers for Disease Control and Prevention is implementing a survey to
collect county level records for Aedes aegypti and Ae. albopictus, the vectors of dengue, yellow fever, chikungunya, and Zika
viruses. This information will be used to update species distribution maps for the contiguous United States and to develop a
model aimed at identifying where these vectors can survive and reproduce. The resulting maps and models will:
• Inform the public and policy makers of the known distribution of these vectors
• Identify gaps in vector surveillance
• Target allocation of surveillance and prevention resources.
To aid in this public health effort, we would be grateful for your voluntary contribution to this knowledge base. If you have
colleagues who might have additional records to share, please forward the link so they are invited to participate as well.
In the interest of timely development of this map, we ask that you complete your survey by March 1, 2016.
This survey is designed to collect records at the county level. If you have surveillance records for more than one county,
please fill out one survey for each county.
If you have any questions, you may contact [email protected].
Thank you for your participation.
* Required
Submitter's Contact Information
Please include contact information for the person submitting the surveillance records and the agency or organization
to which these records should be attributed. This information will be used to follow up with you to confirm accuracy
of your entries prior to finalizing the end report. If you have already submitted a surveillance record, you do not
need to include your phone number and mailing address for subsequent entries.
Submitter's First Name *
Submitter's Last Name *
Phone Number
Please use format: XXX-XXX-XXXX
Email *
Affiliation *
Please list the agency or organization to which these collection records should be attributed.
Street
City
Public reporting burden of this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333;
ATTN: PRA 0920-XXXX
State
Zip code
CDC survey of county-level surveillance records of Aedes aegypti and
Aedes albopictus from 2000 to present
* Required
Which state would you like to submit surveillance records for? *
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CDC survey of county-level surveillance records of Aedes aegypti and
Aedes albopictus from 2000 to present
* Required
Arkansas
Which county would you like to submit surveillance records for? *
This survey is designed to collect records at the county level. If you have surveillance records for more than one
county, please fill out one survey for each county.
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CDC survey of county-level surveillance records of Aedes aegypti and
Aedes albopictus from 2000 to present
* Required
Surveillance records
In which years were at least one Aedes aegypti (any life stage) collected in this county? *
Please check all years that apply.
o
2000
o
2001
o
2002
o
2003
o
2004
o
2005
o
2006
o
2007
o
2008
o
2009
o
2010
o
2011
o
2012
o
2013
o
2014
o
2015
o
2016
o
No Aedes aegypti were collected in this county between 2000 and 2016.
In which years were at least one Aedes albopictus (any life stage) collected in this county? *
Please check all years that apply.
o
2000
o
2001
o
2002
o
2003
o
2004
o
2005
o
2006
o
2007
o
2008
o
2009
o
2010
o
2011
o
2012
o
2013
o
2014
o
2015
o
2016
o
No Aedes albopictus were collected in this county between 2000 and 2016.
Do you have Aedes aegypti or Aedes albopictus records from additional counties? *
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| File Type | application/pdf |
| Author | Hahn, Micah B. (CDC/OID/NCEZID) (CTR) |
| File Modified | 2016-02-09 |
| File Created | 2016-02-09 |