Information Collection

Feedback to Consumer Access to Immunization Information System (IIS)

IC 213799 under ICR 201407-0920-001 · OMB 0920-1026.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Feedback to Consumer Access to Immunization Information System (IIS)	Form
Survey Attachment A_ Consumer Access to Immunization Information System (IIS)_Survey.docx	Form
Attachment B _Email invitation.docx Email Invitation	IC Document
Attachment C_Email Follow Up.docx Email Follow-up	IC Document
Attachment D_Print Image_Consumer Brochure.JPG Consumer Brochure	IC Document
Attachment E_Print Image_Consumer FAQ.JPG Consumer FAQ	IC Document
Attachment F_Print Image_Security.JPG Security Image	IC Document
0920-1026_Feedback on Consumer Access to Immunization Information System 11 7 2014.docx Request for Approval	IC Document

IC Title:

Agency IC Tracking Number:

15BG

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
Form	none	Survey	Attachment A_ Consumer Access to Immunization Information System (IIS)_Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,650

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,650	1,650
Annual IC Time Burden (Hours)	275	275
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email Invitation	Attachment B _Email invitation.docx	11/07/2014
Email Follow-up	Attachment C_Email Follow Up.docx	11/07/2014
Consumer Brochure	Attachment D_Print Image_Consumer Brochure.JPG	11/07/2014
Consumer FAQ	Attachment E_Print Image_Consumer FAQ.JPG	11/07/2014
Security Image	Attachment F_Print Image_Security.JPG	11/07/2014
Request for Approval	0920-1026_Feedback on Consumer Access to Immunization Information System 11 7 2014.docx	11/07/2014

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