Information Collection

NIS 2008 Teen Immunization Questionnaire

IC 186085 under ICR 200811-0920-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
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: Modified

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

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	Previously Approved
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.