Information Collection

Phase 2 completes 54%

IC 205296 under ICR 201402-0910-001 · OMB 0910-0737.

Documents and Forms

Document Name Document Type
APPENDIX 5_Questionnaire Phase 2.doc Other-Phase 2

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Phase 2 completes 54%	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Phase 2			APPENDIX 5_Questionnaire Phase 2.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,800	800	4,000
Annual IC Time Burden (Hours)	4,800	800	4,000
Annual IC Cost Burden (Dollars)	0	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.