Parent-Child Enrollment Questionnaire

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

Documents and Forms

Document Name Document Type
Parent-Child Enrollment Questionnaire Form and Instruction
Parent Child Enrollment Questionnaire Att B9_Parent_Child_Enrollment_Questionnaire_08FEB2018_clean.docx Form and Instruction
Parent Child Enrollment Questionnaire - Spanish Att C9_Cuestionario_inscripcion_padre_bebe_08FEB2018_clean.docx Form and Instruction
Att B9_Parent_Child_Enrollment_Questionnaire_08FEB2018_track.docx Parent Child Enrollment Questionnaire - trkchg IC Document
Att C9_Cuestionario_inscripcion_padre_bebe_08FEB2018_track.docx Parent Child Enrollment Questionnaire - Spanish - trkchg IC Document

Information Collection (IC) Details

IC Title:	Parent-Child Enrollment 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?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Parent Child Enrollment Questionnaire	Att B9_Parent_Child_Enrollment_Questionnaire_08FEB2018_clean.docx		No		Paper Only
Form and Instruction	none	Parent Child Enrollment Questionnaire - Spanish	Att C9_Cuestionario_inscripcion_padre_bebe_08FEB2018_clean.docx		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: 900	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	Previously Approved
Annual Number of Responses for this IC	900	0	900
Annual IC Time Burden (Hours)	225	-75	300
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Parent Child Enrollment Questionnaire - trkchg	Att B9_Parent_Child_Enrollment_Questionnaire_08FEB2018_track.docx	03/26/2018
Parent Child Enrollment Questionnaire - Spanish - trkchg	Att C9_Cuestionario_inscripcion_padre_bebe_08FEB2018_track.docx	03/26/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.