Request For Report Of Immunizations Administered

REQUEST FOR REPORT OF IMMUNIZATIONS ADMINISTERED

OMB: 0915-0030

IC ID: 110088

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no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details

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REQUEST FOR REPORT OF IMMUNIZATIONS ADMINISTERED
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HSA-468 No No


    

500 0
   
Private Sector Businesses or other for-profits
 
   0 %

  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 5,000 0 0 0 0 5,000
Annual IC Time Burden (Hours) 333 0 0 0 0 333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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