Information Collection

Zika Readiness Initiative Survey (U.S. Domestic/Puerto Rico Adults)

IC 227798 under ICR 201707-0920-012 · OMB 0920-1197.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Zika Readiness Initiative Survey (U.S. Domestic/Puerto Rico Adults)	Form and Instruction
Zika Readiness Initiative Questionnaire (U.S./Puerto Ric Attachment E - Zika Readiness Initiative Questionnaire_English 2_15_17.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 Readiness Initiative Questionnaire (U.S./Puerto Rico)	Attachment E - Zika Readiness Initiative Questionnaire_English 2_15_17.docx	NA	No		Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,400

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	2,400	2,400
Annual IC Time Burden (Hours)	560	560
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.