HPV Vaccination Quarterly Reports Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCIRD)

Documents and Forms

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

Information Collection (IC) Details

IC Title:	HPV Vaccination Quarterly Reports Satisfaction Survey	Agency IC Tracking Number:	15ARM

IC Status: New

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	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 %

	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

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.