Initial Telephone Interview

Zika Emergency Package V: Assessment of Interventions Intended to Protect Pregnant Women in Puerto Rico from Zika virus Infections

Documents and Forms

Document Name Document Type
Initial Telephone Interview Form and Instruction
Initial Telephone Interview - ENGLISH 15AUG2016 Attachment C Initial telephone interview ENGLISH-Aug 15.CLEAN.docx Form and Instruction
Initial Telephone Interview - SPANISH 15AUG2016 Attachment C Initial telephone interview Spanish-Aug 15.CLEAN.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: Modified

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 15AUG2016	Attachment C Initial telephone interview ENGLISH-Aug 15.CLEAN.docx	NA	No		Paper Only
Form and Instruction	NA	Initial Telephone Interview - SPANISH 15AUG2016	Attachment C Initial telephone interview Spanish-Aug 15.CLEAN.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.