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Zika Virus Infection Questions for Zika Postpartum Emergency Response (ZPER) Survey
Emergency Zika Package: Zika Postpartum Emergency Response Survey, Puerto Rico, 2016
OMB: 0920-1127
IC ID: 222720
OMB.report
HHS/CDC
OMB 0920-1127
ICR 201607-0920-004
IC 222720
( )
Documents and Forms
Document Name
Document Type
Zika Virus Infection Questions for Zika Postpartum Emergency Response (ZPER) Survey
Form and Instruction
Zika PostparEmergency Response (ZPER) Questionnaire
Att B - Questionnaires_ZPER_072816_OMB clean.doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Zika Virus Infection Questions for Zika Postpartum Emergency Response (ZPER) Survey
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
NA
Zika PostparEmergency Response (ZPER) Questionnaire
Att B - Questionnaires_ZPER_072816_OMB clean.doc
NA
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
0920-0136 - Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 62812
Number of Respondents:
2,760
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
50 %
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
2,760
0
2,760
0
0
0
Annual IC Time Burden (Hours)
690
0
690
0
0
0
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.