Assessment at Delivery Form

CDC Emergency Operations Center Zika Related Clinical Inquiries and Surveillance

OMB: 0920-1101

IC ID: 220150

Documents and Forms
Information Collection (IC) Details

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Assessment at Delivery Form
 
No Modified
 
Voluntary
 

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 - Neonate Assessment Att. F -- Assessment at Delivery Form 31MAR2016.doc NA Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0136 - Epidemiological Studies and Surveillance of Disease Problems  57 FR 82612

100 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  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 100 0 0 0 0 100
Annual IC Time Burden (Hours) 50 0 0 0 0 50
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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