Information Collection

MFS-IP Follow up Survey- 34 months-Male

IC 184574 under ICR 201405-0990-005 · OMB 0990-0331.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0331 can be found here:

Documents and Forms

Document Name Document Type
0990-0331Renewal Appendix A Male Instrument.pdf Other-survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MFS-IP Follow up Survey- 34 months-Male	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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-survey			0990-0331Renewal Appendix A Male Instrument.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 463	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	463	463
Annual IC Time Burden (Hours)	695	695
Annual IC Cost Burden (Dollars)	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.