Information Collection

Pregnant Women - Infant Symptoms Questionnaire

IC 226475 under ICR 201710-0920-013 · OMB 0920-1190.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Pregnant Women - Infant Symptoms Questionnaire	Form
ZEN Colombia: Infant Symptoms - English Att B6_Infant Symptoms_071317_CLEAN.DOCX	Form
ZEN Columbia: Infant Symptoms - Spanish 08SEP2017 Att C6 Sintomas Bebes_Formatted_090517_clean.docx	Form

IC Title:

Pregnant Women - Infant Symptoms Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	none	ZEN Colombia: Infant Symptoms - English	Att B6_Infant Symptoms_071317_CLEAN.DOCX		No		Paper Only
Form	NA	ZEN Columbia: Infant Symptoms - Spanish 08SEP2017	Att C6 Sintomas Bebes_Formatted_090517_clean.docx	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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	31,500	31,500
Annual IC Time Burden (Hours)	5,250	5,250
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.