Information Collection

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

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0331Renewal Appendix A Male Instrument.pdf	Other-survey
0990-0331NonsubstantiveModificationCombined.docx MFS-IP grant programs	IC Document

IC Title:

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.