Male Partners - Adult Symptoms Questionnaire

ZEN Colombia Study: Zika in Pregnant Women and Children in Colombia

OMB: 0920-1190

IC ID: 226478

Information Collection (IC) Details

View Information Collection (IC)

Male Partners - Adult Symptoms Questionnaire
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA ZEN Columbia - Adult Symptoms Questionnaire - English Att B5 - Adult Symptoms_052517_CLEAN.docx NA No   Paper Only
Form none ZEN Colombia: Adult Symptoms - Spanish Att C5_Sintomas Adultos_Formatted_071317_CLEAN.DOCX No   Paper Only

Health Public Health Monitoring

09-20-0113 - Epidemic Investigation Case Records System  51 FR 42466

625 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,375 0 0 0 0 4,375
Annual IC Time Burden (Hours) 729 0 0 0 0 729
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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