Pregnant Women - Pregnant Women Enrollment Questionnaire

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

OMB: 0920-1190

IC ID: 226472

Information Collection (IC) Details

View Information Collection (IC)

Pregnant Women - Pregnant Women Enrollment 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: Pregnant Women Enrollment Questionnaire - Spanish 08SEP2017 Att C2_Inscripcion Gestantes_Formatted_090517_clean.docx NA No   Paper Only
Form and Instruction NA ZEN Columbia - Pregnant Woman Enrollment Questionnaire - English 26MAY2017 Att B2 - Maternal Enrollment_052517_CLEAN.docx NA No   Paper Only

Health Public Health Monitoring

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

2,500 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 2,500 0 0 0 0 2,500
Annual IC Time Burden (Hours) 1,458 0 0 0 0 1,458
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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