View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Domestic Readiness Initiative on Zika Virus Disease 17MZ
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0572 Attachment 4 - Provider Screener_1_13 Attachment 4 - Provider Screener_1_13.docx Yes No Fillable Printable
Form and Instruction 0920-0572 Attachment 5 - Provider Survey_1_13 Attachment 5 - Provider Survey_1_13.docx Yes No Fillable Printable
Form and Instruction 0920-0572 Attatchment 6 - FGPRScreener_1_13 Attatchment 6 - FGPRScreener_1_13.docx No   Fillable Printable
Form and Instruction 0920-0572 Attachment 7 - FGPRGuide_1-13-17 Attachment 7 - FGPRGuide_1-13-17.docx No   Fillable Printable
Form and Instruction 0920-0572 ttachment2 - Consumer Screener for IDICONUS_1_13 ttachment2 - Consumer Screener for IDICONUS_1_13.docx No   Fillable Printable
Form and Instruction 0920-0572 Attachment 3 consumer IDI Guide_l1_13 Attachment 3 consumer IDI Guide_l1_13.docx No   Fillable Printable

Health Illness Prevention

 

575 0
   
Individuals or Households
 
   60 %

  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 575 0 575 0 0 0
Annual IC Time Burden (Hours) 342 0 342 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HMTS Expedited Review Form Domestic Readiness - Zika - final HMTS Expedited Review Form Domestic Readiness - Zika - final .pdf 01/20/2017
Attachment 9 - Justification for Remuneration_1-7 Attachment 9 - Justification for Remuneration_1-7.docx 01/20/2017
Attachment A - Puerto Rico Campaign ImagesScreenShots Attachment A - Puerto Rico Campaign ImagesScreenShots.docx 01/20/2017
Attachment B -Spanish_Stop Zika Campaign Testing (SP) 1-13-2017 Attachment B -Spanish_Stop Zika Campaign Testing (SP) 1-13-2017.pdf 01/20/2017
Attachment C - Consent Language for Provider + Consumer IC Attachment C - Consent Language for Provider + Consumer IC.docx 01/20/2017
Attachment D_ScreenShot for HCP SurveysCONUSandPR Attachment D_ScreenShot for HCP SurveysCONUSandPR.docx 01/20/2017
Attachment E - ScreenShot of Consumer Materials1_13 Attachment E - ScreenShot of Consumer Materials1_13.docx 01/20/2017
Atttachment 8 - FGPRSupplemental Handout_1-13-17 Atttachment 8 - FGPRSupplemental Handout_1-13-17.docx 01/20/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.