Information Collection

Staff and Volunteer Reporting of Existing Vaccination (one-time)

IC 250755 under ICR 202112-0970-005 · OMB 0970-0583.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0583 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Staff and Volunteer Reporting of Existing Vaccination (one-time)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 1302

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 924,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	924,000	924,000
Annual IC Time Burden (Hours)	25,667	25,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.