Readiness Assessment Tool

Health Center COVID-19 Vaccine Program

OMB: 0906-0062

IC ID: 245829

Information Collection (IC) Details

View Information Collection (IC)

Readiness Assessment Tool
 
No Modified
 
Required to Obtain or Retain Benefits
 

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

Health Immunization Management

 

1,467 1,467
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,467 0 103 0 0 1,364
Annual IC Time Burden (Hours) 734 0 52 0 0 682
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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