Initial 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⚠️ Notice: This information collection may be referencing outdated material.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
Initial Telephone Interview Form and Instruction
Initial Telephone Interview - ENGLISH 27JUN2016 Attachment C Initial telephone interview.ENGLISH-June 25.CLEAN.NEW NUMBERS.docx Form and Instruction
Initial Telephone Interview - SPANISH 27JUN2016 Attachment C Initial telephone interview Spanish-June 25.CLEAN.NEW NUMBERS.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Initial Telephone Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	Initial Telephone Interview - ENGLISH 27JUN2016	Attachment C Initial telephone interview.ENGLISH-June 25.CLEAN.NEW NUMBERS.docx	NA	No		Paper Only
Form and Instruction	NA	Initial Telephone Interview - SPANISH 27JUN2016	Attachment C Initial telephone interview Spanish-June 25.CLEAN.NEW NUMBERS.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,800	1,800
Annual IC Time Burden (Hours)	600	600
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.