Vaccination of Critical Workforce - Immunization Informa

Form Approved

OMB Approval No. 0920-xxxx

Expiration Date: xx/xx/xxxx

Vaccination of critical workforce – IIS

Immunization information system (IIS)

a. Total number of targeted CWG enrolled prior to FE

b. Total number enrolled during FE

c. Number of vaccine doses reported to IIS day of FE

d. Reported one to seven days after FE

e. Reported > seven days after FE

f. Total number of doses administered during FE

g. IIS vaccine reporting method

h. Vaccine history screening (primary method)

i. Verify membership in targeted CWG

Public reporting burden of this collection of information is estimated to average 12 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).