Follow-Up Telephone Interview

Zika Emergency Package V: Assessment of Interventions Intended to Protect Pregnant Women in Puerto Rico from Zika virus Infections

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1118 can be found here:

Documents and Forms

Document Name Document Type
Follow-Up Telephone Interview Form and Instruction
Follow-Up Interview - English Attachment D Follow-up Telephone Interview with header and footer.docx Form and Instruction
Follow-Up Interview - Spanish Attachment D Follow-up telephone interview Spanish-June 17 with header and footer.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Follow-Up Telephone Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Follow-Up Interview - English	Attachment D Follow-up Telephone Interview with header and footer.docx	NA	No		Paper Only
Form and Instruction	NA	Follow-Up Interview - Spanish	Attachment D Follow-up telephone interview Spanish-June 17 with header and footer.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	225	225
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.