Information Collection

YSI Program Users (Post-Use Survey)

IC 204464 under ICR 201210-0920-004 · OMB 0920-0951.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
YSI Program Users (Post-Use Survey)	Form
Post-Use Survey Screenshots Att 5A_YSI Program Post-Use Survey_9 17 2012.pdf	Form
Att 5B_Full Version YSI Program Post-Use Survey_ 9 17 2012.docx Word Version - Post-Use Survey	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	none	Post-Use Survey Screenshots	Att 5A_YSI Program Post-Use Survey_9 17 2012.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Word Version - Post-Use Survey	Att 5B_Full Version YSI Program Post-Use Survey_ 9 17 2012.docx	09/27/2012

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