Information Collection

Lead Administrator Site Visit Schedule and Intructions

IC 200885 under ICR 201201-0920-009 · OMB 0920-0927.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Lead Administrator Site Visit Schedule and Intructions	Form and Instruction
3 Site Visit Schedule Instructions and Template Att 5E_Site Visit Instructions and Template.doc	Form and Instruction
Att 5C_Notification Email and Letter.doc Att 5C_Notification Email and Letter	IC Document
Att 5D_Site Visit FAQs.doc Att 5D_Site Visit FAQs	IC Document

IC Title:

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	3	Site Visit Schedule Instructions and Template	Att 5E_Site Visit Instructions and Template.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12

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	12	12
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 5C_Notification Email and Letter	Att 5C_Notification Email and Letter.doc	01/20/2012
Att 5D_Site Visit FAQs	Att 5D_Site Visit FAQs.doc	01/20/2012

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