View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection – American Samoa, 2016	Agency IC Tracking Number:

IC Status: Unchanged

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 Virus Disease Case Investigation Form	Appendix 1. ZIKV Case Investigation Form.pdf	NA	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0113 - Epidemic Investigation Case Records	FR Citation: 51 FR 42466

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	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	800	0	0	0	0	800
Annual IC Time Burden (Hours)	134	0	0	0	0	134
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of Invitation	Letter of Invitation_American Samoa.pdf	02/10/2016
Burden Memo Email - American Samoa	Burden Table Memo - American Samoa.msg	02/10/2016
Emergency GenIC Request - EEI American Samoa	2016008-XXX Zika_AS.docx	02/10/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.