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Individual Questionnaire
Assessment to Estimate the Effect of Community-Wide Vector Control Initiatives on Zika Virus Transmission in Puerto Rico, 2016
OMB: 0920-1137
IC ID: 223311
OMB.report
HHS/CDC
OMB 0920-1137
ICR 201608-0920-013
IC 223311
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1137 can be found here:
2016-09-27 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Individual Questionnaire
Form and Instruction
Zika Investigation - Individual Interview Form SPANISH
Att H - Individual questionnaire SPANISH.doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Individual 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
NA
Zika Investigation - Individual Interview Form SPANISH
Att H - Individual questionnaire SPANISH.doc
NA
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
09-20-0113 Epidemic Investigation Case Records Systems Notice
FR Citation:
51 FR 42466
Number of Respondents:
500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
1,000
0
1,000
0
0
0
Annual IC Time Burden (Hours)
500
0
500
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.