Information Collection

Pretest

IC 197990 under ICR 201106-0935-002 · OMB 0935-0183.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form #2 Pretest	Form and Instruction
Form #2 Draft Pretest Questionnaire Attachment C -- Draft Pretest Questionnaire 2-8-11.doc	Form and Instruction
Attachment D -- Pretest Cover Letter and Reminder Notice 2-8-11.docx Attachment D -- Pretest Cover Letter and Reminder Notice 2-8-11	IC Document

IC Title:

Pretest

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	Form #2	Draft Pretest Questionnaire	Attachment C -- Draft Pretest Questionnaire 2-8-11.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	627	627
Annual IC Time Burden (Hours)	157	157
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment D -- Pretest Cover Letter and Reminder Notice 2-8-11	Attachment D -- Pretest Cover Letter and Reminder Notice 2-8-11.docx	05/31/2011

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