Follow-Up Telephone Interview

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

Documents and Forms

Document Name Document Type
Follow-Up Telephone Interview Form and Instruction
Follow-Up Telephone Interview - ENGLISH Attachment D Follow-up Telephone Interview ENGLISH.March 2.CLEAN.docx Form and Instruction
Follow-Up Telephone Interview - SPANISH Attachment D Follow-up telephone interview SPANISH March 2.CLEAN.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Follow-Up 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	Follow-Up Telephone Interview - ENGLISH	Attachment D Follow-up Telephone Interview ENGLISH.March 2.CLEAN.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Follow-Up Telephone Interview - SPANISH	Attachment D Follow-up 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: 600	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	600	600
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.