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

Knowledge, Attitudes, and Practices related to a Domestic Readiness Initiative on Zika Virus Disease

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Zika Readiness Initiative Survey (U.S. Domestic/Puerto Rico Adults)	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 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 %

	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

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.