Information Collection

Zika Readiness Initiative Survey - Puerto Rico Adults

IC 223458 under ICR 201609-0920-020 · OMB 0920-1136.

Documents and Forms

Document Name Document Type
Zika Readiness Initiative Survey - Puerto Rico Adults Form and Instruction
Zika Readiness Initiative Questionnaire - English Attachment D - Zika Readiness Initiative Questionnaire (English)_Clean.docx Form and Instruction
Zika Readiness Initiative Questionnaire - Spanish Attachment E - Zika Readiness Initiative Questionnaire (Spanish) clean.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Zika Readiness Initiative Survey - Puerto Rico Adults	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 Readiness Initiative Questionnaire - English	Attachment D - Zika Readiness Initiative Questionnaire (English)_Clean.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Zika Readiness Initiative Questionnaire - Spanish	Attachment E - Zika Readiness Initiative Questionnaire (Spanish) clean.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,800	-1,800	3,600
Annual IC Time Burden (Hours)	360	-360	720
Annual IC Cost Burden (Dollars)	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.