Information Collection

Smallpox Vaccine Injury Compensation Program

IC 6536 under ICR 200708-0915-003 · OMB 0915-0282.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form request form Smallpox Vaccine Injury Compensation Program	Form
0282 Request instructions.doc	Instruction
request form request form 0282 Request Form.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 102

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	request form	request form	0282 Request Form.doc		Yes	No	Fillable Printable
Instruction			0282 Request instructions.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Smallpox Vaccine Injury Compensation Program, HHS/HRSA/OSP

FR Citation: 68 FR 62301

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	25	-2,475	2,500
Annual IC Time Burden (Hours)	125	-7,375	7,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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