Information Collection

Infant Health Follow-Up Form

IC 220151 under ICR 201603-0920-014 · OMB 0920-1101.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Infant Health Follow-Up Form	Form and Instruction
Pregnancy and Zika Virus Disease Surveillance Form - Inf Att. G -- Infant Health Follow-Up Form 31MAR2016.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 2 / 6 / 12 Month	Att. G -- Infant Health Follow-Up Form 31MAR2016.doc	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: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
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.