Pregnant Women - Ages and Stages 6 Month Questionnaire

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1190 can be found here:

Documents and Forms

Document Name Document Type
Pregnant Women - Ages and Stages 6 Month Questionnaire Form and Instruction
Ages and Stages Questionnaire - 6 month English Att B9_Ages and Stages-6_Months.pdf Form and Instruction
Ages and Stages Questionnaire - 6 month Spanish Att C9-Ages and Stages-6_Month_spanish.pdf Form and Instruction
Ages and Stages Questionnaire - 4 month English Att B9_Ages and Stages-4_Months.pdf Form and Instruction
Ages and Stages Questionnaire - 4 month Spanish Att C9-Ages and Stages-4_Month_spanish.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Pregnant Women - Ages and Stages 6 Month Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Electronic Capability
Form and Instruction	NA	Ages and Stages Questionnaire - 6 month English	Att B9_Ages and Stages-6_Months.pdf	NA	No	Paper Only
Form and Instruction	NA	Ages and Stages Questionnaire - 6 month Spanish	Att C9-Ages and Stages-6_Month_spanish.pdf	NA	No	Paper Only
Form and Instruction	NA	Ages and Stages Questionnaire - 4 month English	Att B9_Ages and Stages-4_Months.pdf	NA	No	Paper Only
Form and Instruction	NA	Ages and Stages Questionnaire - 4 month Spanish	Att C9-Ages and Stages-4_Month_spanish.pdf	NA	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0113 - Epidemic Investigation Case Records System	FR Citation: 51 FR 42466

Number of Respondents: 2,250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,250	2,250
Annual IC Time Burden (Hours)	563	563
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.