Follow-Up Survey

Persistence of Zika virus in semen and urine of adult men in the United States with confirmed Zika virus infection

Documents and Forms

Document Name Document Type
Follow-Up Survey Form and Instruction
First Follow-Up Survey - English Att. D1 -- First Follow-Up Survey.docx Form and Instruction
First Follow-Up Survey - Spanish Att. D1 -- First Follow-up Survey ESP.docx Form and Instruction
Follow-Up Survey - English Att. D2 -- Follow-up Survey.docx Form and Instruction
Follow-Up Survey - Spanish Att. D2 -- Follow-up Survey ESP.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Follow-Up 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?	Electronic Capability
Form and Instruction	NA	First Follow-Up Survey - English	Att. D1 -- First Follow-Up Survey.docx	NA	No	Paper Only
Form and Instruction	NA	First Follow-Up Survey - Spanish	Att. D1 -- First Follow-up Survey ESP.docx	NA	No	Paper Only
Form and Instruction	NA	Follow-Up Survey - English	Att. D2 -- Follow-up Survey.docx	NA	No	Paper Only
Form and Instruction	NA	Follow-Up Survey - Spanish	Att. D2 -- Follow-up Survey ESP.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 Problemsl	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	3,000	3,000
Annual IC Time Burden (Hours)	50	50
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.