Information Collection

Registration Form and Data Submission

IC 192645 under ICR 202004-0935-001 · OMB 0935-0165.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0165 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Registration Form and Data Submission Form and Instruction
1 Attachment D: Registration Form Attachment C -- Registration Form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Registration Form and Data Submission	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	1	Attachment D: Registration Form	Attachment C -- Registration Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 85	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	85	85
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.