Zika Virus Disease Enhanced Surveillance – Hospitalization associated with Zika virus disease

Zika Virus Enhanced Surveillance of Selected Populations

Documents and Forms

Document Name Document Type
Zika Virus Disease Enhanced Surveillance – Hospitalization associated with Zika virus disease Form
Zika Virus Disease Enhanced Surveillance – Hospitalizati Att. 5 - Enhanced surveillance - Hospitalized.docx Form

Information Collection (IC) Details

IC Title:	Zika Virus Disease Enhanced Surveillance – Hospitalization associated with Zika virus disease	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	NA	Zika Virus Disease Enhanced Surveillance – Hospitalization associated with Zika virus disease	Att. 5 - Enhanced surveillance - Hospitalized.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: 12	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	120	120
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.