OMB control number

CDC Emergency Operations Center Zika Related Clinical Inquiries and Surveillance

OMB 0920-1101 · HHS/CDC.

OMB 0920-1101

Latest Forms, Documents, and Supporting Material

Document Name
Survey of County-Level Surveillance Records of Aedes aegypti and Aedes albopictus Form and Instruction
Infant Health Follow-Up Form Form and Instruction
Assessment at Delivery Form Form and Instruction
Clinical Inquiries Database Form and Instruction
Maternal Health History Form Form and Instruction
Clinical Inquiries Database Form and Instruction
Att. D -- Overview Letter - Revised 31MAR2016_OMB.docx Supplementary Document
0920-1101 Non-sub Change Request_4_7_16 FINAL.docx Justification for No Material/Nonsubstantive Change
Att. S -- CSTE Case Definition.pdf Supplementary Document
0920-1101 Non-sub Change Request_4_7_16.docx Justification for No Material/Nonsubstantive Change
Att. R -- Fact sheet for Health Departments.docx Supplementary Document
Att. Q -- Fact sheet for pediatric healthcare providers.docx Supplementary Document
Att. P -- Fact sheet for obstetric healthcare providers.docx Supplementary Document
Att. N -- Pregnancy Registry Information Sheet.docx Supplementary Document
Att. M -- IRB determination.pdf Supplementary Document
Att. C -- Website Information - Zika Virus Disease and Pregnancy Registry 31MAR2016.docx Supplementary Document
Att. M -- IRB determination.pdf Supplementary Document
Att. R -- Definitions for case inclusion.docx Supplementary Document
Att. Q -- CSTE Case Definition.pdf Supplementary Document
Att. P -- Fact Sheet for Health Care Providers.pdf Supplementary Document
Att. O -- Developmental Milestones for Infant.docx Supplementary Document
Att. N -- Pregnancy Registry Information Sheet Revised 31MAR2016.pdf Supplementary Document
Att. D -- Overview Letter - Revised 31MAR2016.docx Supplementary Document
0920-1101 Non-sub Change Request.docx Justification for No Material/Nonsubstantive Change
Att. B -- 60-Day FRN - ZIKA.docx Supplementary Document
Zika Emergency 1_SSB_non sub change CLEAN.docx Supporting Statement B
Zika Emergency 1 SSA non sub change CLEAN_4_7_16.docx Supporting Statement A
Att. M -- IRB Approval Pregnancy Registry.pdf Supplementary Document
Att. L -- IRB Approval Mosquito survey.pdf Supplementary Document
Att. K -- IRB Approval Call Center.pdf Supplementary Document
Att. A -- 42 USC 241.pdf Supplementary Document
Signed memo 021616.pdf Supplementary Document
Survey of County-Level Surveillance Records of Aedes aegypti and Aedes albopictus Form and Instruction
Infant Health Follow-Up Form Form and Instruction
Assessment at Delivery Form Form and Instruction
Clinical Inquiries Database Form and Instruction
Specimen Collection Form Instruction
Maternal Health History Form Form and Instruction
Clinical Inquiries Database Form and Instruction

All Historical Document Collections

201603-0920-014 Approved with change	No material or nonsubstantive change to a currently approved collection	2016-04-01
201602-0920-005 Approved with change	New collection (Request for a new OMB Control Number)	2016-02-18