Zika Readiness Initiative Survey - U.S. Domestic Adults

Knowledge, Attitudes, and Practices related to a Domestic Readiness Initiative on Zika Virus Disease

Documents and Forms

Document Name Document Type
Zika Readiness Initiative Survey - U.S. Domestic Adults Form and Instruction
Zika Readiness Initiative Questionnaire - English Attachment D - Zika Readiness Initiative Questionnaire (English)_Clean.docx Form and Instruction
Zika Readiness Initiative Questionnaire - Spanish Attachment E - Zika Readiness Initiative Questionnaire (Spanish) clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Zika Readiness Initiative Survey - U.S. Domestic Adults	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	Zika Readiness Initiative Questionnaire - English	Attachment D - Zika Readiness Initiative Questionnaire (English)_Clean.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Zika Readiness Initiative Questionnaire - Spanish	Attachment E - Zika Readiness Initiative Questionnaire (Spanish) clean.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,400	1,800	3,600
Annual IC Time Burden (Hours)	1,080	360	720
Annual IC Cost Burden (Dollars)	0	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.