Parent-Child Follow-Up Questionnaire

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

Documents and Forms

Document Name Document Type
Parent-Child Follow-Up Questionnaire Form
Parent Child Followup Questionnaire Att B10_Parent_Child_Followup_Questionnaire_08FEB2018_clean.docx Form
Parent Child Followup Questionnaire - Spanish Att C10_Cuestionario_seguimiento_padre-nino_08FEB2018_clean.docx Form
Att B10_Parent_Child_Followup_Questionnaire_08FEB2018_track.docx Parent Child Followup Questionnaire - trkchg IC Document
Att C10_Cuestionario_seguimiento_padre-nino_08FEB2018_track.docx Parent Child Followup Questionnaire - Spanish - trkchg IC Document

Information Collection (IC) Details

IC Title:	Parent-Child Follow-Up 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	none	Parent Child Followup Questionnaire	Att B10_Parent_Child_Followup_Questionnaire_08FEB2018_clean.docx		No		Paper Only
Form	none	Parent Child Followup Questionnaire - Spanish	Att C10_Cuestionario_seguimiento_padre-nino_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	3,600	0	3,600
Annual IC Time Burden (Hours)	600	-300	900
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Parent Child Followup Questionnaire - trkchg	Att B10_Parent_Child_Followup_Questionnaire_08FEB2018_track.docx	03/26/2018
Parent Child Followup Questionnaire - Spanish - trkchg	Att C10_Cuestionario_seguimiento_padre-nino_08FEB2018_track.docx	03/26/2018

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