Information Collection

Program-level data

IC 204800 under ICR 201211-0920-007 · OMB 0920-0959.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0959 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Program-level data	Form and Instruction
Program-level data Att5 Programmatic Reporting Template_HEPTLC.pdf	Form and Instruction

IC Title:

Program-level data

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	none	Program-level data	Att5 Programmatic Reporting Template_HEPTLC.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	160	160
Annual IC Time Burden (Hours)	240	240
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.