Telephone Follow-Up Survey (New Version)

Zika Postpartum Emergency Response Survey (ZPER), Puerto Rico, 2017

Documents and Forms

Document Name Document Type
Form 0920-1199 Telephone Follow-Up Survey (New Version) Form and Instruction
0920-1199 ZPER Telephone Follow-Up Questionnaire - English Att 9a Telephone Follow-up Survey_English_OMB change request_122117_clean.docx Form and Instruction
0920-1199 ZPER Telephone Follow-Up Questionnaire - Spanish Att 9b Telephone Follow-up Survey_Spanish_122118_clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Telephone Follow-Up Survey (New Version)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1199	ZPER Telephone Follow-Up Questionnaire - English	Att 9a Telephone Follow-up Survey_English_OMB change request_122117_clean.docx	NA	No		Paper Only
Form and Instruction	0920-1199	ZPER Telephone Follow-Up Questionnaire - Spanish	Att 9b Telephone Follow-up Survey_Spanish_122118_clean.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: 1,520	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,520	1,520
Annual IC Time Burden (Hours)	304	304
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.