Information Collection

Data Submission

IC 201169 under ICR 201202-0935-005 · OMB 0935-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0196 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form #4 Example Screen Shots of Web Site Information Collection Data Submission	Form
Form #4 Example Screen Shots of Web Site Information Collection Attachment J - Example Screen Shots Web Site Information Collection.docx	Form
Attachment I - Emails - MO SOPS Data Submission.doc Attachment I - Emails - MO SOPS Data Submission	IC Document
Attachment K - MO Data File Specs.pdf Attachment K - MO Data File Specs	IC Document

IC Title:

Data Submission

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	Form #4				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	150	150
Annual IC Time Burden (Hours)	675	675
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment I - Emails - MO SOPS Data Submission		02/09/2012
Attachment K - MO Data File Specs		02/09/2012

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

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