Influenza Vaccine Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Influenza Vaccine Survey	Agency IC Tracking Number:

IC Status: New

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	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 %

	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

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.