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Zika Clinical Inquiries Database - State/Local Health Department
CDC Emergency Operations Center: Zika Related Clinical Inquiries
OMB: 0920-1159
IC ID: 222837
OMB.report
HHS/CDC
OMB 0920-1159
ICR 201608-0920-003
IC 222837
( )
Documents and Forms
Document Name
Document Type
Zika Clinical Inquiries Database - State/Local Health Department
Form and Instruction
2016 Zika Virus Inquiry Log
Att. C- Zika Clinical Inquiries Database.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Zika Clinical Inquiries Database - State/Local Health Department
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
2016 Zika Virus Inquiry Log
Att. C- Zika Clinical Inquiries Database.pdf
NA
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 62812
Number of Respondents:
420
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
420
0
420
0
0
0
Annual IC Time Burden (Hours)
105
0
105
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.