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

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

View Information Collection (IC)

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.