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Neonate Assessment at Delivery Form
US Zika Pregnancy Registry
OMB: 0920-1143
IC ID: 222497
OMB.report
HHS/CDC
OMB 0920-1143
ICR 201607-0920-002
IC 222497
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1143 can be found here:
2017-10-31 - No material or nonsubstantive change to a currently approved collection
2017-03-03 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Neonate Assessment at Delivery Form
Form and Instruction
Neonate Assessment at Delivery Form
ATT_C_USZPR_Neonate_Assessment_At_Delivery_Revised 21SEP2016.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Neonate Assessment at Delivery Form
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
Neonate Assessment at Delivery Form
ATT_C_USZPR_Neonate_Assessment_At_Delivery_Revised 21SEP2016.docx
NA
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Epidemiologic Studies and Surveillance of Disease Problems; 09-20-0136
FR Citation:
57 FR 62812
Number of Respondents:
1,100
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
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
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.