Hospital-based Survey for Mothers

Zika Postpartum Emergency Response Survey (ZPER) - Puerto Rico 2017

OMB: 0920-1183

IC ID: 226837

Information Collection (IC) Details

View Information Collection (IC)

Hospital-based Survey for Mothers
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA ZPER Maternal Hospital-based Questionnaire - Spanish Att 7b Hospital-based Survey for Mothers_Spanish.doc.docx NA Yes Yes Fillable Fileable
Form and Instruction NA Maternal Hospital-based Questionnaire - English Screenshot Att 7c Hospital-based Survey for Mothers_English_tablet screenshots.pdf NA Yes Yes Fillable Fileable
Form and Instruction NA ZPER Maternal Hospital-based Questionnaire - English Att 7a Hospital-based Survey for Mothers _English.doc NA Yes Yes Fillable Fileable
Form and Instruction NA ZPER Maternal Hospital-based Questionnaire - Spanish Screenshot Att 7d Hospital-based Survey for Mothers_Spanish_table screenshots.pdf NA Yes Yes Fillable Fileable

Health Public Health Monitoring

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

3,120 0
   
Individuals or Households
 
   10 %

  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 3,120 0 3,120 0 0 0
Annual IC Time Burden (Hours) 1,300 0 1,300 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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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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