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Zika Pilot Study Data Collection Form
Zika Virus Pilot Project
OMB: 0906-0036
IC ID: 231808
OMB.report
HHS/HRSA
OMB 0906-0036
ICR 201809-0906-001
IC 231808
( )
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Zika Pilot Study Data Collection Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
1
Zika Data Elements Instrument.docx
20180511 Zika Data Elements Instrument CLEAN.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,160
0
0
0
0
1,160
Annual IC Time Burden (Hours)
589
0
0
0
0
589
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
