Addendum to COVID-19 Data Collection Survey Tool

Health Center COVID-19 Vaccine Program

OMB: 0906-0062

IC ID: 245831

Information Collection (IC) Details

View Information Collection (IC)

Addendum to COVID-19 Data Collection Survey 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 4 ADDENDUM Health Center COVID-19 Vaccine Program FORM 4 - ADDENDUM Health Center COVID-19 Vaccine Program.docx Yes Yes Fillable Fileable

Health Immunization Management

 

1,389 1,389
   
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 66,672 0 0 0 0 66,672
Annual IC Time Burden (Hours) 33,336 0 0 0 0 33,336
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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