Information Collection

Correction, Revision to Action, Correction of Revision to Action, Void, Action on Appeal

IC 206480 under ICR 201304-0915-002 · OMB 0915-0126.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0126 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Correction, Revision to Action, Correction of Revision to Action, Void, Action on Appeal	Form and Instruction
1 Correction, Revision to Action, Correction of Revision t 1.Correction,RevisiontoAction,Void,NoticeofAppeal.pdf	Form and Instruction

IC Title:

Correction, Revision to Action, Correction of Revision to Action, Void, Action on Appeal

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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	1	Correction, Revision to Action, Correction of Revision to Action, Void, Action on Appeal	1.Correction,RevisiontoAction,Void,NoticeofAppeal.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 38,785

Number of Respondents for Small Entity: 5,000

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
Annual Number of Responses for this IC	38,785	38,785
Annual IC Time Burden (Hours)	9,696	9,696
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.