Information Collection

Vaccination of Critical Workforce (Immunization Information System)

IC 247432 under ICR 202105-0920-005 · OMB 0920-1352.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1352 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Vaccination of Critical Workforce (Immunization Information System)	Form and Instruction
Vaccination of Critical Workforce - Immunization Informa Att38-Vaccination of Criticical Workforce- IIS.docx	Form and Instruction
Vaccination of Critical Workforce - Immunization Informa Att38-Vaccination of Criticical Workforce- IIS.docx	Form and Instruction

IC Title:

Vaccination of Critical Workforce (Immunization Information System)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form and Instruction	n/a	Vaccination of Critical Workforce - Immunization Information System (IIS)	Att38-Vaccination of Criticical Workforce- IIS.docx		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 62

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	62	62
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	393	393

Documents for IC

table that charts IC Documents
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.