Telephone Interview of Cases and Controls

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
Telephone Interview of Cases and Controls Form and Instruction
Case-Control Interview - English 13JUL2016 Case-control Interview 7.12.docx Form and Instruction
Case-Control Interview - Spanish 13JUL2016 Case-control Interview 7.12 Spanish.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Telephone Interview of Cases and Controls	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	Case-Control Interview - English 13JUL2016	Case-control Interview 7.12.docx	NA	No		Paper Only
Form and Instruction	NA	Case-Control Interview - Spanish 13JUL2016	Case-control Interview 7.12 Spanish.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	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	200	200
Annual IC Time Burden (Hours)	67	67
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.