Introductory Survey

Zika Emergency Package III: Persistence of Zika virus in semen and urine of adult men with confirmed Zika virus infection

Documents and Forms

Document Name Document Type
Introductory Survey Form and Instruction
Verbal Script for Consent and Introductory Survey Att. C -- Verbal Script for Consent and Introductory Survey.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Introductory Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	Verbal Script for Consent and Introductory Survey	Att. C -- Verbal Script for Consent and Introductory Survey.docx	NA	No		Paper Only

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: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	8	8
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.