Information Collection

HC COVID-19 Vaccine Prgrm Conditions of Participation Agreement

IC 248937 under ICR 202108-0906-001 · OMB 0906-0062.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 HC COVID-19 Vaccine Prgrm Conditions of Participation Agreement	Form and Instruction
1 HC COVID-19 Vaccine Prgrm Conditions of Participation Ag FORM 1 - HC COVID-19 Vaccine Prgrm Conditions of Participation Agreement 8-16-21.pdf	Form and Instruction
1 HC COVID-19 Vaccine Prgrm Conditions of Participation Ag FORM 1 - HC COVID-19 Vaccine Prgrm Conditions of Participation Agreement 8-16-21.pdf	Form and Instruction

IC Title:

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	1	HC COVID-19 Vaccine Prgrm Conditions of Participation Agreement 8-16-21.pdf	FORM 1 - HC COVID-19 Vaccine Prgrm Conditions of Participation Agreement 8-16-21.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

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: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,467	1,467
Annual IC Time Burden (Hours)	367	367
Annual IC Cost Burden (Dollars)	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.