Information Collection

Control Questionnaire

IC 197043 under ICR 201406-0920-007 · OMB 0920-0905.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Control Questionna Control Questionnaire	Form
Control Questionna Control Questionnaire Control Questionnaire_10-31-11.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	Control Questionnaire	Control Questionnaire	Control Questionnaire_10-31-11.doc		No		Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 483

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	483	483
Annual IC Time Burden (Hours)	201	201
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.