SEVERE NEUROLOGIC ILLNESS Chart Abstraction Questionnaire

Zika Virus Associated Neurologic Illness Case Control Study in Puerto Rico

OMB: 0920-1141

IC ID: 223950

Information Collection (IC) Details

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SEVERE NEUROLOGIC ILLNESS Chart Abstraction Questionnaire
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Chart Abstraction Questionnaire for the Investigation of Severe Neurologic Illness in relation to Arboviral Infections CaCo Chart Abstraction Questionnaire_Severe Neuro_4Oct.docx NA Yes Yes Fillable Fileable

Health Illness Prevention

09-20-0136 - Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

10 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 60 0 60 0 0 0
Annual IC Time Burden (Hours) 60 0 60 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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