Information Collection

57.130 Vaccination Monthly Monitoring Form - Summary Method

IC 183567 under ICR 201407-0920-007 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Document Name Document Type
Form 57.130 57.130 Vaccination Monthly Monitoring Form - Summary Method Form
57.130 Vaccination Monthly Monitoring - Summary Method 57.130_VaccMonthlyReportingSummary_BLANK.DOCX Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.130 Vaccination Monthly Monitoring Form - Summary Method	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	57.130	Vaccination Monthly Monitoring - Summary Method	57.130_VaccMonthlyReportingSummary_BLANK.DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-500	500
Annual IC Time Burden (Hours)	-7,000	7,000
Annual IC Cost Burden (Dollars)	-264,880	264,880

Documents for IC

Title	Document	Date Uploaded
No associated records found

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