Survey and Consent - Zika Reproductive Health and Emergency Response Call-Back Survey (ZRHER), 2018

Zika Reproductive Health and Emergency Response Call-Back Survey, 2018

Documents and Forms

Document Name Document Type
Survey and Consent - Zika Reproductive Health and Emergency Response Call-Back Survey (ZRHER), 2018 Form and Instruction
Survey and Consent - ZRHER Att 5 ZRHER Survey and Consent_11-3-2017.docx Form and Instruction
Survey and Consent - ZRHER Spanish Att 5S ZRHER Survey and Consent SPANISH.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Survey and Consent - Zika Reproductive Health and Emergency Response Call-Back Survey (ZRHER), 2018	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	NA	Survey and Consent - ZRHER	Att 5 ZRHER Survey and Consent_11-3-2017.docx	NA	No		Paper Only
Form and Instruction	NA	Survey and Consent - ZRHER Spanish	Att 5S ZRHER Survey and Consent SPANISH.docx	NA	No		Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	9,700	9,700
Annual IC Time Burden (Hours)	1,617	1,617
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.