Pregnant Women - Pregnant Women Eligibility Questionnaire

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

OMB: 0920-1190

IC ID: 226464

Information Collection (IC) Details

View Information Collection (IC)

Pregnant Women - Pregnant Women Eligibility 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 Eligibility - English 08SEP2017 Att B1 - Woman Eligibility Screening Form_090617_clean.docx NA No   Paper Only
Form and Instruction NA ZEN Columbia: Pregnant Women Eligibility - Spanish 08SEP2017 Att C1_Form de Eleg_Mujeres_090617_CLEAN.DOCX NA No   Paper Only

Health Public Health Monitoring

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

600 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 600 0 -2,525 0 0 3,125
Annual IC Time Burden (Hours) 50 0 -210 0 0 260
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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