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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.