Information Collection

Study Phase 2 Main Study

IC 206931 under ICR 201305-0910-005 · OMB 0910-0743.

Documents and Forms

Document Name Document Type
Phase 2 Pretest and Main Test Survey.docx Other-Pretest

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Study Phase 2 Main Study	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Pretest			Phase 2 Pretest and Main Test Survey.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,740	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,740	1,740
Annual IC Time Burden (Hours)	522	522
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.