Information Collection

MFS-IP Follow-up Survey-(9/18 month)Male

IC 184572 under ICR 201506-0990-005 · OMB 0990-0331.

Documents and Forms

Document Name Document Type
0990-0331Renewal Appendix A Male Instrument.pdf Other-survey
0990-0331NonsubstantiveModificationCombined.docx MFS-IP grant programs IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MFS-IP Follow-up Survey-(9/18 month)Male	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
Other-survey			0990-0331Renewal Appendix A Male Instrument.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 321	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	321	321
Annual IC Time Burden (Hours)	482	482
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
MFS-IP grant programs	0990-0331NonsubstantiveModificationCombined.docx	07/23/2014

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