Intercept Interview with Pregnant Women - USVI

Assessment of Zika Prevention Strategies in the U.S. Virgin Islands

Documents and Forms

Document Name Document Type
Intercept Interview with Pregnant Women - USVI Form and Instruction
Intercept Interview with Pregnant Women - USVI Attachment C.Interview with Pregnant Women in USVI.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Intercept Interview with Pregnant Women - USVI	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Intercept Interview with Pregnant Women - USVI	Attachment C.Interview with Pregnant Women in USVI.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0136, “Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 300	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
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	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.