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 Yes No Fillable Printable
Form and Instruction 0920-0572 Yes No Fillable Printable
Form and Instruction 0920-0572 No   Fillable Printable
Form and Instruction 0920-0572 No   Fillable Printable
Form and Instruction 0920-0572 No   Fillable Printable
Form and Instruction 0920-0572 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 01/20/2017
Attachment 9 - Justification for Remuneration_1-7 01/20/2017
Attachment A - Puerto Rico Campaign ImagesScreenShots 01/20/2017
Attachment B -Spanish_Stop Zika Campaign Testing (SP) 1-13-2017 01/20/2017
Attachment C - Consent Language for Provider + Consumer IC 01/20/2017
Attachment D_ScreenShot for HCP SurveysCONUSandPR 01/20/2017
Attachment E - ScreenShot of Consumer Materials1_13 01/20/2017
Atttachment 8 - FGPRSupplemental Handout_1-13-17 01/20/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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