Information Collection

Zika Virus Infection Questions for Zika Postpartum Emergency Response (ZPER) Survey

IC 222720 under ICR 201607-0920-004 · OMB 0920-1127.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Zika PostparEmergency Response (ZPER) Questionnaire Zika Virus Infection Questions for Zika Postpartum Emergency Response (ZPER) Survey	Form and Instruction
Zika PostparEmergency Response (ZPER) Questionnaire Att B - Questionnaires_ZPER_072816_OMB clean.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA			NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 0920-0136 - Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 2,760

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,760	2,760
Annual IC Time Burden (Hours)	690	690
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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