Information Collection

NIS 2008 Teen Immunization Questionnaire

IC 186085 under ICR 200808-0920-005 · OMB 0920-0214.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0214 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC 64.122 NIS 2008 Teen Immunization Questionnaire	Form
CDC 64.122 National Immunization Survey - Teen Attachment4 NIS Teen Questionnaire.pdf	Form
Not assigned NIS 2008 Teen Immunization Questionnaire Attachment4 NHIS Teen Questionnaire Updated.pdf	Form and Instruction
Attachment4 Cover.doc Cover sheet for NIS Teen Questionnaire	IC Document

IC Title:

NIS 2008 Teen Immunization Questionnaire

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	CDC 64.122	National Immunization Survey - Teen	Attachment4 NIS Teen Questionnaire.pdf		Yes	No	Paper Only
Form and Instruction	Not assigned	NIS 2008 Teen Immunization Questionnaire	Attachment4 NHIS Teen Questionnaire Updated.pdf		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population

FR Citation: 49 FR 37693

Number of Respondents: 4,800

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,800	4,800
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover sheet for NIS Teen Questionnaire	Attachment4 Cover.doc	08/07/2008

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