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

Zika Reproductive Health Call-Back Survey (ZRHCS), PUERTO RICO 2017

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Zika Reproductive Health Call-Back Survey (ZRHCS) - Puerto Rico, 2017 Call Back Survey	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	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 %

	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

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.