Household Representative Questionnaire

Communities Organized to Prevent Arboviruses: Assessment of Knowledge, Attitudes, and Vector Control Practices and Sero-Prevalence and Incidence of Arborviral Infection in Ponce, Puerto Rico (COPA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1254 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-18ANU Household Representative Questionnaire Form and Instruction
0920-18ANU Household Representative Questionnaire 4. Attachment 4_EN ES Paper Questionnaire - COPA Y1 COMBINED.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Household Representative Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	0920-18ANU	Household Representative Questionnaire	4. Attachment 4_EN ES Paper Questionnaire - COPA Y1 COMBINED.pdf	NA	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 2,720	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
Annual Number of Responses for this IC	2,720	2,720
Annual IC Time Burden (Hours)	454	454
Annual IC Cost Burden (Dollars)	3,292	3,292

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.