Initial Telephone Interview

Assessment of Interventions Intended to Protect Pregnant Women in Puerto Rico from Zika virus Infections

Documents and Forms

Document Name Document Type
Initial Telephone Interview Form and Instruction
Initial Telephone Interview - ENGLISH Attachment C Initial telephone interview ENGLISH-March 2.CLEAN.docx Form and Instruction
Initial Telephone Interview - SPANISH Attachment C Initial telephone interview SPANISH.March 2.CLEAN.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Initial Telephone Interview	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	Initial Telephone Interview - ENGLISH	Attachment C Initial telephone interview ENGLISH-March 2.CLEAN.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Initial Telephone Interview - SPANISH	Attachment C Initial telephone interview SPANISH.March 2.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: 1,200	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	1,200	1,200
Annual IC Time Burden (Hours)	400	400
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.