Information Collection

Third-Party Disclosure (Date Format)

IC 203298 under ICR 201612-0910-002 · OMB 0910-0720.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0720 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Third-Party Disclosure (Date Format)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 21 CFR 801.18 21 CFR 801.20 21 CFR 801.35 21 CFR 801.50 21 CFR 820 21 CFR 830.60 21 CFR 801.40 21 CFR 830.310 21 CFR 830.320

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

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,066

Number of Respondents for Small Entity: 200

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-210,766	210,766
Annual IC Time Burden (Hours)	-210,766	210,766
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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