Information Collection

Readiness Assessment Tool

IC 245829 under ICR 202108-0906-001 · OMB 0906-0062.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Readiness Assessment Tool	Form and Instruction
INSTRUCTION - HC COVID-19 Vaccine Pgrm Readiness Assessment User Guide.pdf	Instruction
INSTRUCTION - HC COVID-19 Vaccine Pgrm Readiness Assessment User Guide.pdf	Instruction
2 Health Center COVID-19 Vaccine Program Readiness Assessm FORM 2 - Health Center COVID-19 Vaccine Program Readiness Assessment 8-21.pdf	Form and Instruction
2 Health Center COVID-19 Vaccine Program Readiness Assessm FORM 2 - Health Center COVID-19 Vaccine Program Readiness Assessment 8-21.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	2	Health Center COVID-19 Vaccine Program Readiness Assessment 8-21	FORM 2 - Health Center COVID-19 Vaccine Program Readiness Assessment 8-21.pdf		Yes	Yes	Fillable Fileable
Instruction			INSTRUCTION - HC COVID-19 Vaccine Pgrm Readiness Assessment User Guide.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,467

Number of Respondents for Small Entity: 1,467

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,467	103	1,364
Annual IC Time Burden (Hours)	734	52	682
Annual IC Cost Burden (Dollars)	0	0	0

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.