Information Collection

Authorization form for the MEPS-MPC Pharmacy Survey

IC 204198 under ICR 201412-0935-002 · OMB 0935-0118.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0118 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form #1 Authorization form for the MEPS-MPC Pharmacy Survey	Form and Instruction
Form #1 Authorization form for the MEPS-MPC Pharmacy Survey Attachment 24 -- HC Authorization Form for the MEPS-MPC - Pharmacy.doc	Form and Instruction

IC Title:

Authorization form for the MEPS-MPC Pharmacy Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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 and Instruction	Form #1	Authorization form for the MEPS-MPC Pharmacy Survey	Attachment 24 -- HC Authorization Form for the MEPS-MPC - Pharmacy.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14,489

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	44,916	44,916
Annual IC Time Burden (Hours)	2,246	2,246
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.