Information Collection

Assessing Key Factors to Pharmacy Enrollments in the Vaccines for Children Program

IC 213482 under ICR 201402-0920-018 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
B_Interview Guide.docx Other-WORD
EUH8-VFC-SSA.docx Supporting Statement A IC Document
EUH8-VFC-SSB.docx Supporting Statement B IC Document
A_VFC Infographic.pdf Att A-Infographic Summary IC Document
C_ASTHO Summary.pdf Att C - ASTHO Report Summary IC Document
D_VFC Project Overview.pdf Att D-VFC Project Overview IC Document
E_Participant Notification Email.docx Att E-Participants Notification Email IC Document
F_SHO Notification Email.docx Att F-SHO Notification Email IC Document
G_Reminder Email.docx Att G-Reminder E-mail IC Document
H_Confirmation Email.docx Att H-Confirmation Email IC Document
I_Thank You Email.docx Att I-Thank You E-mail IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Assessing Key Factors to Pharmacy Enrollments in the Vaccines for Children Program	Agency IC Tracking Number:	15BK

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-WORD			B_Interview Guide.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	EUH8-VFC-SSA.docx	10/14/2014
Supporting Statement B	EUH8-VFC-SSB.docx	10/14/2014
Att A-Infographic Summary	A_VFC Infographic.pdf	10/14/2014
Att C - ASTHO Report Summary	C_ASTHO Summary.pdf	10/14/2014
Att D-VFC Project Overview	D_VFC Project Overview.pdf	10/14/2014
Att E-Participants Notification Email	E_Participant Notification Email.docx	10/14/2014
Att F-SHO Notification Email	F_SHO Notification Email.docx	10/14/2014
Att G-Reminder E-mail	G_Reminder Email.docx	10/14/2014
Att H-Confirmation Email	H_Confirmation Email.docx	10/14/2014
Att I-Thank You E-mail	I_Thank You Email.docx	10/14/2014

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