Information Collection

Introductory Survey

IC 222241 under ICR 201606-0920-018 · OMB 0920-1139.

Documents and Forms

Document Name Document Type
Introductory Survey Form and Instruction
Study of Zika Virus Shedding in Semen and Urine of Adult Att. C -- Verbal Script for Consent and Introductory Survey.docx Form and Instruction
Study of Zika Virus Shedding in Semen and Urine of Adult Att. C -- Verbal script for consent and introductory survey ESP.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Introductory Survey	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	Study of Zika Virus Shedding in Semen and Urine of Adult Men - Phone Script and Consent - English	Att. C -- Verbal Script for Consent and Introductory Survey.docx	NA	No		Paper Only
Form and Instruction	NA	Study of Zika Virus Shedding in Semen and Urine of Adult Men - Phone Script and Consent - Spanish	Att. C -- Verbal script for consent and introductory survey ESP.docx	NA	No		Paper Only

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: 250	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	250	250
Annual IC Time Burden (Hours)	83	83
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.