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

Emergency Zika Package: Zika Postpartum Emergency Response Survey, Puerto Rico, 2016

Documents and Forms

Document Name Document Type
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

Information Collection (IC) Details

IC Title:	Zika Virus Infection Questions for Zika Postpartum Emergency Response (ZPER) 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?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Zika PostparEmergency Response (ZPER) Questionnaire	Att B - Questionnaires_ZPER_072816_OMB clean.doc	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 %

	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

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.