Information Collection

Media Tracking Screener

IC 208713 under ICR 201502-0910-009 · OMB 0910-0753.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0753 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
12 Attachment 4_Media Tracking Screener and Instrument 0910-0753.doc	Other-Media Tracking Screener
13 Rationale for Item Changes to the ExPECTT Media Tracking Instrument 0901-0753.docx	Other-Rationale for Item Changes to

IC Title:

Media Tracking Screener

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Media Tracking Screener			12 Attachment 4_Media Tracking Screener and Instrument 0910-0753.doc		Yes	No	Printable Only
Other-Rationale for Item Changes to Media Tracking Instrument			13 Rationale for Item Changes to the ExPECTT Media Tracking Instrument 0901-0753.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 39,999

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	Previously Approved
Annual Number of Responses for this IC	39,999	39,999
Annual IC Time Burden (Hours)	1,200	1,200
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.