Information Collection

Zika Pilot Study Data Collection Form

IC 231808 under ICR 201809-0906-001 · OMB 0906-0036.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Zika Pilot Study Data Collection Form	Form
1 Zika Data Elements Instrument.docx 20180511 Zika Data Elements Instrument CLEAN.docx	Form

IC Title:

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	1	Zika Data Elements Instrument.docx	20180511 Zika Data Elements Instrument CLEAN.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,160	1,160
Annual IC Time Burden (Hours)	589	589
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.