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

View Information Collection (IC)

Assessment of the Zika Care Connect Program 0920-1154-18JN
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1154 Invitation Email to access Survey - Health Care Professional Attachment 6_Email and Reminder Email - Survey of Healthcare Professiona....docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-1154 Reminder Invitation Email to access Survey - Health Care Professional Attachment 6_Email and Reminder Email - Survey of Healthcare Professiona....docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-1154 Survey - Healthcare Professional Attachment 4_Information Collection Instrument - Survey of Healthcare Pr....docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-1154 Pop-Up Invitation to Survey - Website User Attachment 5_Information Collection Instrument - Survey of Website Users....docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-1154 Survey - Website User Attachment 5_Information Collection Instrument - Survey of Website Users....docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

4,080 0
   
Individuals or Households
 
   100 %

  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 4,080 0 4,080 0 0 0
Annual IC Time Burden (Hours) 260 0 260 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A SSA_ZCC eval_ver2_clean.docx 12/26/2017
Supporting Statement B SSB_ZCC evaluation_ver2_clean.docx 12/26/2017
IRB Determination Attachment 3_ IRB determination Letter.pdf 12/26/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.