OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Vaccine Site Data - Outreach to Community Members Form - Booster Vaccines

IC 249594 under ICR 202109-0906-002 · OMB 0906-0064.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 4
Vaccine Site Data - Outreach to Community Members Form - Booster Vaccines		 Form and Instruction
4 Community Based Vaccine Outreach Program Reporting Modul
FORM - Community Based Vaccine Outreach Program Reporting Module 09-22-2021.docx 		Form and Instruction
4 Community Based Vaccine Outreach Program Reporting Modul
FORM - Community Based Vaccine Outreach Program Reporting Module 09-22-2021.docx 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 4 Community Based Vaccine Outreach Program Reporting Module - Booster Vaccines 09-22-2021.docx FORM - Community Based Vaccine Outreach Program Reporting Module 09-22-2021.docx Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 4,000,000 0 4,000,000 0 0 0
Annual IC Time Burden (Hours) 466,667 0 466,667 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
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.