Household Questionnaire

Assessment to Estimate the Effect of Community-Wide Vector Control Initiatives on Zika Virus Transmission in Puerto Rico, 2016

OMB: 0920-1137

IC ID: 223310

Information Collection (IC) Details

View Information Collection (IC)

Household Questionnaire
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Zika Investigation - Household Interview Form ENGLISH Att G - Household questionnaire.docx NA No   Paper Only
Form and Instruction NA Zika Investigation - Household Interview Form SPANISH Att G - Household Questionnaire SPANISH.docx NA No   Paper Only

Health Public Health Monitoring

09-20-0113 Epidemic Investigation Case Records Systems Notice  51 FR 42466

200 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 200 0 200 0 0 0
Annual IC Time Burden (Hours) 60 0 60 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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