Information Collection

PRC Indicator Survey

IC 37806 under ICR 201303-0920-013 · OMB 0920-0650.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0650 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PRC Indicator Survey	Form
PRC Indicator Data Collection Web Survey Attatchment 4B_WebSurvey_ScreenShots2.docx	Form
PRC Indicator Data Collection Web Survey Attachment 4A_Webbased survey_2272013.doc	Form

IC Title:

PRC Indicator Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	PRC Indicator Data Collection Web Survey	Attatchment 4B_WebSurvey_ScreenShots2.docx		Yes	Yes	Fillable Fileable
Form	none	PRC Indicator Data Collection Web Survey	Attachment 4A_Webbased survey_2272013.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 37

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	37	0	37
Annual IC Time Burden (Hours)	185	-37	222
Annual IC Cost Burden (Dollars)	0	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.