Clinical Inquiries Database

CDC Emergency Operations Center Zika Related Clinical Inquiries and Surveillance

Documents and Forms

Document Name Document Type
Clinical Inquiries Database Form and Instruction
2016 Zika Virus Inquiry Log Att. I -- Domestic Zika Clinical Inquiries Database.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Clinical Inquiries Database	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	2016 Zika Virus Inquiry Log	Att. I -- Domestic Zika Clinical Inquiries Database.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 420	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	420	420
Annual IC Time Burden (Hours)	105	105
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.