Information Collection

Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection - Puerto Rico, 2016

IC 220062 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⚠️ Notice: This information collection may be referencing outdated material.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 - Puerto Rico, 2016	Form and Instruction
Zika Virus Disease Case Investigation Form Appendix 1. ZIKV Case Investigation Form.pdf	Form and Instruction
2016 Urgent Assessment of Blood Collection and Use in Pu Appendix 2 Blood collection assessment 16FEB2016.doc	Form and Instruction
Signed ZIKA LOI.pdf Letter of Invitation - Puerto Rico 2016	IC Document
1. GenIC Request Form - EEI Generic ICR_Zika_PR.docx GenIC Request - EEI Zika_Puerto Rico 2016	IC Document
Zika_Puerto Rico 2016 Burden Memo.msg Zika_Puerto Rico 2016 _ Burden Memo	IC Document

IC Title:

Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection - Puerto Rico, 2016

Agency IC Tracking Number:

0920-1011-16PS

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
Form and Instruction	NA	2016 Urgent Assessment of Blood Collection and Use in Puerto Rico in Response to the Zika Virus Outbreak	Appendix 2 Blood collection assessment 16FEB2016.doc	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: 102

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	102	102
Annual IC Time Burden (Hours)	77	77
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter of Invitation - Puerto Rico 2016	Signed ZIKA LOI.pdf	02/16/2016
GenIC Request - EEI Zika_Puerto Rico 2016	1. GenIC Request Form - EEI Generic ICR_Zika_PR.docx	02/16/2016
Zika_Puerto Rico 2016 _ Burden Memo	Zika_Puerto Rico 2016 Burden Memo.msg	02/16/2016

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