Household Forms

National Immunization Survey Evaluation Study

OMB: 0607-0954

IC ID: 188379

Documents and Forms
Document Name
Document Type
Other-Director's Advance Letter for
Other-Director's Advance Letter for
Other-Advance Letter Informational B
Other-Informational Refusal Letter
Other-Director's Advance Letter for
Other-Director's Advance Letter for
Form
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Household Forms
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Director's Advance Letter for Households - ACS Sample - Spanish Attachment I 7317-100A(S) OMB 04_23_2009.doc No   Paper Only
Other-Director's Advance Letter for Households - Alternative Sampling Frame - Spanish Attachment J 7317-100B(S) OMB 04_23_2009.doc No   Paper Only
Other-Director's Advance Letter for Households ? ACS Sample Attachment B 7317-100A OMB 04_23_2009.pdf No   Paper Only
Other-Director's Advance Letter for Households ? Alternative Sampling Frame Attachment C 7317-100B OMB 04_23_2009.pdf No   Paper Only
Other-Advance Letter Informational Brochure Attachment D 7317-ALB OMB 04_23_2009.doc No   Paper Only
Other-Informational Refusal Letter Attachment E 7317-IRL OMB 4_23_2009.doc No   Paper Only
Form 7317-IB Information Collection Instrument Items Booklet Attachment F 7317-IB OMB 06_03_2009.rtf Yes Yes Fillable Fileable
Form 7317-IBS Information Collection Instrument Items Booklet - Spanish Attachment G 7317-IBS OMB 06_03_2009.rtf Yes Yes Fillable Fileable
Form 7317-PPQ Immunization Survey Paper Questionnaire Attachment H 7317-PPQ OMB 06_03_2009.doc No   Paper Only
Form 7317-110E Permission to Contact Immunization Provider - English Attachment K 7317-110E OMB 06_03_2009.pdf No   Paper Only
Form 7317-110S Permission to Contact Immunization Provider - Spanish Attachment L 7317-110S OMB 06_03_2009.pdf No   Paper Only

General Government Central Records & Statistical Mgt

 

1,307 0
   
Individuals or Households
 
   44 %

  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 1,307 0 0 0 0 1,307
Annual IC Time Burden (Hours) 616 0 0 0 0 616
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
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