OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Feedback to Consumer Access to Immunization Information System (IIS)

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

Documents and Forms
Document Name
Document Type
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Feedback to Consumer Access to Immunization Information System (IIS) 15BG
 
New
 
Voluntary
 

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

Health Consumer Health and Safety

 

1,650 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,650 0 1,650 0 0 0
Annual IC Time Burden (Hours) 275 0 275 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.