Information Collection

Zika Readiness Initiative Survey - U.S. Domestic Adults

IC 223456 under ICR 201609-0920-020 · OMB 0920-1136.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.