Information Collection

Zika-positive Pregnant Women - Pregnant Women Follow-Up Questionnaire

IC 228856 under ICR 201710-0920-006 · OMB 0920-1217.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Zika-positive Pregnant Women - Pregnant Women Follow-Up Questionnaire	Form and Instruction
ZIRP - Pregnant Woman Follow-Up Questionnaire Att C4- Pregnant Woman Follow-up Questionnaire (v2).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	ZIRP - Pregnant Woman Follow-Up Questionnaire	Att C4- Pregnant Woman Follow-up Questionnaire (v2).docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136 - Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 150

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	4,500	4,500
Annual IC Time Burden (Hours)	600	600
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.