Information Collection

2015 Immunization Awardee Meeting Evaluation

IC 217768 under ICR 201407-0920-001 · OMB 0920-1026.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2015 Immunization Awardee Meeting Evaluation	Form
Evaluation Survey Attachment 2_2015 Immunization Awardee Meeting Evaluation_Survey_Screenshots.pdf	Form
Attachment 1_2015 Immunization Awardee Meeting IAM Evaluation_Survey.docx Survey - Word Doc	IC Document
Attachment 3_ 2015 Immunization Awardee Meeting_Invite email.docx Email Invite	IC Document
Attachment 4_2015 Immunization Awardee Meeting _Reminder Email.docx Email Reminder	IC Document
GenIC 0920-1026_2015 Immunization Awardee Meeting Evaluation.docx Request for Approval	IC Document

IC Title:

Agency IC Tracking Number:

15BBH

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	Evaluation Survey	Attachment 2_2015 Immunization Awardee Meeting Evaluation_Survey_Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 242

Number of Respondents for Small Entity: 10

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	242	242
Annual IC Time Burden (Hours)	32	32
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey - Word Doc	Attachment 1_2015 Immunization Awardee Meeting IAM Evaluation_Survey.docx	08/04/2015
Email Invite	Attachment 3_ 2015 Immunization Awardee Meeting_Invite email.docx	08/04/2015
Email Reminder	Attachment 4_2015 Immunization Awardee Meeting _Reminder Email.docx	08/04/2015
Request for Approval	GenIC 0920-1026_2015 Immunization Awardee Meeting Evaluation.docx	08/04/2015

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