Information Collection

NY Online Screener

IC 201467 under ICR 201407-0923-001 · OMB 0923-0044.

Documents and Forms

Document Name Document Type
NY Online Screener Form
NY Online Screener Att6c_NY_OnlnScreen_LA_20120619.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NY Online Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	NY Online Screener	Att6c_NY_OnlnScreen_LA_20120619.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 778	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	778	778
Annual IC Time Burden (Hours)	65	65
Annual IC Cost Burden (Dollars)	0	0

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.