Information Collection

Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection – American Samoa, 2016

IC 220060 under ICR 201604-0920-011 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection – American Samoa, 2016	Form and Instruction
Zika Virus Disease Case Investigation Form Appendix 1. ZIKV Case Investigation Form.pdf	Form and Instruction
Letter of Invitation_American Samoa.pdf Letter of Invitation	IC Document
Burden Table Memo - American Samoa.msg Burden Memo Email - American Samoa	IC Document
2016008-XXX Zika_AS.docx Emergency GenIC Request - EEI American Samoa	IC Document

IC Title:

Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection â American Samoa, 2016

Agency IC Tracking Number:

IC Status: Unchanged

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	Zika Virus Disease Case Investigation Form	Appendix 1. ZIKV Case Investigation Form.pdf	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0113 - Epidemic Investigation Case Records

FR Citation: 51 FR 42466

Number of Respondents: 800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	134	134
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter of Invitation	Letter of Invitation_American Samoa.pdf	02/10/2016
Burden Memo Email - American Samoa	Burden Table Memo - American Samoa.msg	02/10/2016
Emergency GenIC Request - EEI American Samoa	2016008-XXX Zika_AS.docx	02/10/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.