Community-based Mosquito Surveillance - Pregnant Women (NCEZID)

CDC I-Catalyst Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1158 can be found here:

Documents and Forms

Document Name Document Type
Community-based Mosquito Surveillance - Pregnant Women (NCEZID) Form and Instruction
Community-based Mosquito Surveillance – Pregnant Women I Interview Guide _Mosquito Surveillance_Women_10232017.docx Form and Instruction
I-Catalyst Template_Mosquito Surveillance_Comm_10232017.docx I-Catalyst Template_Mosquito Surveillance_Interviews with Women IC Document
SS-A Community-based Mosquito Surveillance_10232017.docx Supporting Statement A - Interviews with Pregnant Women IC Document

Information Collection (IC) Details

IC Title:	Community-based Mosquito Surveillance - Pregnant Women (NCEZID)	Agency IC Tracking Number:	0920-18AR

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	n/a	Community-based Mosquito Surveillance – Pregnant Women Interview Guide and Questions	Interview Guide _Mosquito Surveillance_Women_10232017.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	597	597

Documents for IC

Title	Document	Date Uploaded
I-Catalyst Template_Mosquito Surveillance_Interviews with Women	I-Catalyst Template_Mosquito Surveillance_Comm_10232017.docx	10/23/2017
Supporting Statement A - Interviews with Pregnant Women	SS-A Community-based Mosquito Surveillance_10232017.docx	10/23/2017

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