Contraceptive Assessment Screen

Emergency Zika Package IV: Assessment of Contraceptive Use and Needs, Puerto Rico, 2016

OMB: 0920-1114

IC ID: 221549

Documents and Forms
Information Collection (IC) Details

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Contraceptive Assessment Screen
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA CONTRACEPTIVE ASSESSMENT FOR PUERTO RICO DURING ZIKA (CAPRZ) QUESTIONNAIRE Contraceptive Assessmentl 6-14-16.docx NA Yes Yes Fillable Fileable

Health Consumer Health and Safety

09-20-0113 Epidemic Investigation Case Records  51 FR 42466

12,000 0
   
Individuals or Households
 
   100 %

  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 12,000 0 0 0 0 12,000
Annual IC Time Burden (Hours) 200 0 0 0 0 200
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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