Zika Readiness Initiative Survey - U.S. Domestic Adults

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

OMB: 0920-1136

IC ID: 223456

Information Collection (IC) Details

View Information Collection (IC)

Zika Readiness Initiative Survey - U.S. Domestic Adults
 
No Modified
 
Voluntary
 

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

Health Public Health Monitoring

 

5,400 0
   
Individuals or Households
 
   100 %

  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 5,400 0 1,800 0 0 3,600
Annual IC Time Burden (Hours) 1,080 0 360 0 0 720
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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