Information Collection

HPV Vaccination Quarterly Reports Satisfaction Survey

IC 217154 under ICR 201407-0920-001 · OMB 0920-1026.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HPV Vaccination Quarterly Reports Satisfaction Survey	Form
Survey Attachment 1_HPV Quarterly Reports Satisfaction Survey.docx	Form
Attachment 2_Email to Participate in the HPV Quarterly Reports Satisfaction Survey.docx Email to Participate	IC Document
GenIC 0920-1026_HPV Quarterly Reports Satisfaction Survey_revised 6 22 2015.docx Request for Approval	IC Document

IC Title:

Agency IC Tracking Number:

15ARM

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 1_HPV Quarterly Reports Satisfaction Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	56	56
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email to Participate	Attachment 2_Email to Participate in the HPV Quarterly Reports Satisfaction Survey.docx	06/22/2015
Request for Approval	GenIC 0920-1026_HPV Quarterly Reports Satisfaction Survey_revised 6 22 2015.docx	06/22/2015

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