Neonate Assessment at Delivery Form

US Zika Pregnancy Registry

OMB: 0920-1143

IC ID: 222497

Information Collection (IC) Details

View Information Collection (IC)

Neonate Assessment at Delivery Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Neonate Assessment at Delivery Form ATT_C_USZPR_Neonate_Assessment_At_Delivery_Revised 21SEP2016.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

Epidemiologic Studies and Surveillance of Disease Problems; 09-20-0136  57 FR 62812

1,100 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 11,000 0 11,000 0 0 0
Annual IC Time Burden (Hours) 5,500 0 5,500 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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