Information Collection

NY Consent - Burmese

IC 201473 under ICR 201210-0923-001 · OMB 0923-0044.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0044 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NY Consent - Burmese	Form
NY Consent - Burmese Att6i_NY_Consent_Brms_20120712.docx	Form
NY Consent - Burmese translation Att6i_NY_Consent_Brms_20120712(Burmese Translation).pdf	Form

IC Title:

NY Consent - Burmese

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	NY Consent - Burmese	Att6i_NY_Consent_Brms_20120712.docx		No	No	Paper Only
Form	none	NY Consent - Burmese translation	Att6i_NY_Consent_Brms_20120712(Burmese Translation).pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	50	50
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.