Information Collection

Third-Party Disclosure (UDI)

IC 203297 under ICR 201309-0910-013 · OMB 0910-0720.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0720 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Third-Party Disclosure (UDI)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 21 CFR 801.18 21 CFR 801.20 21 CFR 801.35 21 CFR 801.50 21 CFR 820 21 CFR 830.60

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 12

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	635,101	635,101
Annual IC Time Burden (Hours)	7,930	7,930
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.