Information Collection

MUH Operator Baseline Survey - MN, ME, FL

IC 204438 under ICR 201309-0920-011 · OMB 0920-1004.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
MUH Operator Baseline Survey - MN, ME, FL	Form
MUH Operator Baseline Survey - MN, ME, FL clean 12.17.13 Att 6A(e) Baseline Operator Survey_9.3.13.doc	Form
clean 12.17.13 Att 6A-2(e) MUH Operator Survey Consent MN ME FL_9.3.13 c....docx Consent MN, ME, FL	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	none	MUH Operator Baseline Survey - MN, ME, FL	clean 12.17.13 Att 6A(e) Baseline Operator Survey_9.3.13.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent MN, ME, FL	clean 12.17.13 Att 6A-2(e) MUH Operator Survey Consent MN ME FL_9.3.13 c....docx	12/19/2013

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