30-month Follow-up Survey for Z-CAN patients who did not complete the 18-month Follow-up Survey

Assessment of a Preventive Service Program in the Context of a Zika Virus Outbreak in Puerto Rico

OMB: 0920-1241

IC ID: 232335

Information Collection (IC) Details

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30-month Follow-up Survey for Z-CAN patients who did not complete the 18-month Follow-up Survey
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Screenshots of the 30-month Follow-up Survey (Version B for Z-CAN patients who did not complete the 18-month Follow-up Survey) Att H-6 Patient Survey 30 mo Ver B Screen Shots.pdf Yes Yes Fillable Fileable
Other-Word version of survey content for reference/editing (English and Spanish) Att H-3 Patient Survey 30 mo version B (Eng and Span).docx No   Paper Only

Disaster Management Emergency Response

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

220 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 220 0 0 0 0 220
Annual IC Time Burden (Hours) 37 0 0 0 0 37
Annual IC Cost Burden (Dollars) 266 0 0 0 0 266

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