Information Collection

Control Questionnaire

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

Documents and Forms

Document Name Document Type
Form Control Questionna Control Questionnaire Form
Control Questionna Control Questionnaire Control Questionnaire_10-31-11.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Control Questionnaire	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
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 %

	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

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.