Data Submission Layout - PRA BRFSS Coordinators

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

Documents and Forms

Document Name Document Type
Data Submission Layout - PRA BRFSS Coordinators Form
Puerto Rico BRFSS Coordinator Electronic Datas Submissio ZRHCS_Data submission Layout.pdf Form

Information Collection (IC) Details

IC Title:	Data Submission Layout - PRA BRFSS Coordinators	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	Puerto Rico BRFSS Coordinator Electronic Datas Submission Layout	ZRHCS_Data submission Layout.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	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	3	3
Annual IC Time Burden (Hours)	9	9
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.