Information Collection

Influenza Vaccine Survey

IC 223254 under ICR 201501-0925-004 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Influenza Vaccine Survey	Form
1 2016 Flu Survey 2016_Flu_Survey.png	Form
FINAL Fast Track Request - Flu Vaccine.doc Influenza Vaccine Survey	IC Document

IC Title:

Influenza Vaccine Survey

Agency IC Tracking Number:

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	1	2016 Flu Survey	2016_Flu_Survey.png		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	1,400	1,400
Annual IC Time Burden (Hours)	47	47
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Influenza Vaccine Survey	FINAL Fast Track Request - Flu Vaccine.doc	08/30/2016

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