Information Collection

Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection - Brazil, 2016

IC 220061 under ICR 201608-0920-012 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection - Brazil, 2016	Form and Instruction
Survey Questionnaire Appendix 1. Survey Questionnaire.doc	Form and Instruction
Chart Abstraction Appendix 2. Chart Abstraction.doc	Form
Letter of Invitation_Brazil.pdf Letter of Invitation - Brazil	IC Document
Burden Memo Zika_Brazil.msg Burden Memo Request Email	IC Document
2016009-XXX Zika_Brazilv2.docx Emergency GenIC Request - Brazil	IC Document

IC Title:

Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection - Brazil, 2016

Agency IC Tracking Number:

IC Status: Unchanged

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	Survey Questionnaire	Appendix 1. Survey Questionnaire.doc	NA	No		Paper Only
Form	NA	Chart Abstraction	Appendix 2. Chart Abstraction.doc	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0113 - Epidemic Investigation Case Records

FR Citation: 51 FR 42466

Number of Respondents: 685

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	685	685
Annual IC Time Burden (Hours)	320	320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter of Invitation - Brazil	Letter of Invitation_Brazil.pdf	02/11/2016
Burden Memo Request Email	Burden Memo Zika_Brazil.msg	02/11/2016
Emergency GenIC Request - Brazil	2016009-XXX Zika_Brazilv2.docx	02/11/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.