Information Collection

Zika Reproductive Health Call-Back Survey (ZRHCS) - Puerto Rico, 2017 Call Back Survey

IC 227415 under ICR 201704-0920-008 · OMB 0920-1188.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Zika Reproductive Health Call-Back Survey (ZRHCS) - Puerto Rico, 2017 Call Back Survey	Form and Instruction
Zika Reproductive Health Call-Back Survey (ZRHCS) - Puer Att 3 ZRHCS Survey.DOCX	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Zika Reproductive Health Call-Back Survey (ZRHCS) - Puerto Rico, 2017 Call Back Survey	Att 3 ZRHCS Survey.DOCX	NA	No		Paper Only

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,162

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,162	1,162
Annual IC Time Burden (Hours)	194	194
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.